Notice of Privacy Practices

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.

Commitment to your privacy

Berman Counseling (“The Practice”) is dedicated to maintaining the privacy of your personal health information (PHI) as part of providing professional care. Our Notice of Privacy Practices provides information about how we may use and disclose protected health information about you. The Notice contains information on Patient Rights and information on privacy standards set by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). You have the right to review this Notice before signing a Consent that agrees that you have received this information, understand the privacy practices presented, and agree to them. The terms of our Privacy Notice may change. If we change our Notice, you may obtain a revised copy by contacting our office.

How I use and disclose your protected health information with your consent:

The information collected about you will be used to provide you with treatment, to arrange payment for our services, and for some other business activities that are called for in health care operations. After you have read this notice you will be asked to sign a consent form (Authorization to Release Healthcare Information) to allow your provider to share your protected health information with people or agencies of your choice. You will be asked to designate what information will be sent or shared. The patient has the right to restrict how their personal health information is shared, however clinical staff are not required to agree to this restriction if it is not clinically appropriate. The Practice may condition receipt of treatment upon the execution of a consent. The clinical staff at Berman Counseling will continuously work to protect your privacy even with a signed authorization for release of information.

Disclosing your health information without your consent:

There are times when the laws require providers to use or share your information without your consent.

  1. When there is a serious threat to you or another’s health and safety or to the public. Information will only be shared with person(s) who are able to prevent or reduce the threat.

  2. When there is concern about abuse or neglect.

  3. When required to do so by lawsuits and other legal or court proceedings.

  4. If a law enforcement official requires information to be shared.

  5. For workers’ compensation and similar benefit programs.

There are some other rare situations. They are described further in the Health Insurance Portability and Accountability Act. For further information visit https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

Policies and client’s rights:

  1. Signing the Consent for Services agrees that protected health information may be disclosed or used for treatment, payment, and health care operations.

  2. The Practice has a Notice of Privacy Practices and the client has the opportunity to review.

  3. The Practice reserves the right to change the Notice of Privacy Practices.

  4. The client has the right to restrict the uses of their information but the Practice does not have to agree to the restrictions.

  5. The client may revoke consents to release information in writing at any time and all future disclosures will then cease.

  6. The client may request to have information in records amended if they believe that there is information that is inaccurate or incomplete.

  7. You have the right to ask this Practice to communicate with you in a particular way, such as, you can ask to be called on your cell phone and request that messages not be left for you at work.

  8. You have the right to look at the health information I have about you, such as your medical and billing records. You can get a copy of these records, but there may be a charge for it. The Practice may deny this request if there is reasonable belief that viewing these records may cause harm to you or others involved in treatment.

  9. You have the right to request a list of whom your PHI has been shared with.

  10. You have the right to choose someone to act for you such as a medical power attorney or legal guardian

  11. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint by contacting the Practice using the following information:

Berman Counseling LLC

matt@bermancounselingllc.com

Matthew Berman

732-451-4152

You can file a complaint with the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling (202) 619-0257 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. The Practice will not retaliate against you for filing a complaint. All complaints must be in writing. Filing a complaint will not change the health care I provide to you in any way. Also, you may have other rights that are granted to you by the laws of our state, and these may be the same as or different from the rights described above. I will be happy to discuss these situations with you now or as they arise. If you have any questions regarding this notice or health information privacy policies, please let me know.

12. The Practice will notify you if there is a breach