Notice of Privacy Practices

Warwick Family Services, Inc. and Affiliates
Warwick House, Inc., Warwick Family Based Program, Inc.,
Maternal Child Consortium, Inc.,
Maternal Child Consortium, Inc.

800 Clarmont Avenue, Suite B, Bensalem, PA 19020
1460 Meetinghouse Road, Hartsville, PA 18974

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. please review it carefully.

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information used or disclosed to us in any form, whether electronically, on paper or orally be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

Without your specific written authorization, we are permitted to use and disclose your health care records for the purposes of treatment, payment and health care operations.

• Treatment means providing, coordinating, or managing health care and related services by one or more health care providers so our organization can treat you or assist others in your treatment. Examples would include doctors, nurses, pharmacists, social workers, therapists and affiliated health care personnel as well as hospitals, clinics, nursing homes, residential treatment facilities, laboratory and diagnostic facilities etc. Treatment would also include sharing information with your family or care partner if they will be involved in your care and treatment.
• Payment means such activities as confirming insurance coverage, obtaining reimbursement for services, billing /collection activities and utilization review. Payment may also require that we provide details regarding your pre-treatment condition and/or periodic updates concerning your progress to obtain payment for required services.
• Health Care Operations include the business aspects of operating our business, such as conducting quality assessment and improvement activities internally and through accrediting and credentialing organizations, auditing and corporate compliance functions, cost-management analysis and customer service.

In addition, your confidential information may be used to remind you of an appointment (by phone or mail), to provide you with information about treatment alternatives or other health related services or to solicit your opinion regarding the quality of our services. Finally, our organization will disclose your private information when we are required to do so by federal, state or local law, statute or regulation. Examples, any other use or disclosure will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have certain rights in regard to your protected health information, which you may exercise by presenting a written request to our Privacy Officer at the location listed below. Although under specific circumstances these rights may be limited, generally they include:

• The right to have your personal health information kept confidential.
• The right to know why we need to ask questions about your past medical history and current medical condition, and the right to refuse to answer such questions.
• The right to request restrictions in our use or disclosure of your protected health information for treatment, payment or health care operations including that related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are however, not required to agree to such a restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
• The right to request to receive confidential communications of protected health information from us by alternative means or at alternative locations.
• The right to request an amendment to your protected health information if you believe that it is incorrect or incomplete.
• The right to access, inspect and copy your protected health information. Our organization may charge a fee for copying and mailing such information.
• The right to receive an "accounting of disclosures" or list of certain protected health information disclosures our organization has made excluding those related to treatment, payment and health care operations. Under certain circumstances, there may be a charge for compiling this list.
• The right to obtain a paper copy of this notice from us upon request.
• The right to file a complaint if you believe your privacy rights have been violated.
• The right to provide an authorization for other use and disclosure that is not identified in this notice or permitted by applicable law.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

We are also required to advise you that some of our employees who make home visits or home deliveries may wear uniforms or name tags which bear our company's name or logo thus alerting others that you are receiving services from our company.

This notice is effective as of April 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from this office.

You have the right to file a formal, written complaint with us at the address below, or with the Department of Health and Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.

For more information about our privacy practices, please contact:

Maureen Stoll, Privacy Officer
800 Clarmont Ave, Suite B
Bensalem, PA 19020
Phone: 267-525-7000

For more information about HIPAA or to file a complaint:

The U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue SW
Washington, D.C. 20201
Phone: 877-696-6775