Functional Medicine Associates LLC

Effective Date: August 4, 2025

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

OUR RESPONSIBILITIES

Functional Medicine Associates LLC is committed to protecting your personal health information (PHI). We are required by law to:
– Maintain the privacy and security of your PHI.
– Provide you with this Notice of our legal duties and privacy practices.
– Follow the terms of this Notice currently in effect.
– Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

USES AND DISCLOSURES OF YOUR INFORMATION

We may use and disclose your PHI without your written authorization for the following purposes:
Treatment: To provide, coordinate, and manage health care services for you and/or your dependents. This includes telehealth platforms such as video consultations, secure messaging, and phone calls. We may consult with other health care providers or referral services as necessary.
Payment: To obtain payment for telehealth or in-person services, including billing and insurance claims.
Health Care Operations: To improve care quality, conduct training, manage clinic operations, perform quality assessments, business management, and other related activities.

Other Permitted or Required Uses and Disclosures:
– As required by law or for law enforcement purposes.
– For public health activities (e.g., reporting communicable diseases, abuse, adverse drug reactions, or product recalls).
– For health oversight activities including audits and investigations.
– To prevent or lessen a serious threat to health or safety.
– In response to a court order, subpoena, or administrative request with appropriate legal authorization.
– In the event of a breach of unsecured PHI as required by federal and state law.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

We will obtain your written authorization before:
– Using your PHI for marketing purposes.
– Selling your PHI.
– Sharing psychotherapy notes (unless permitted under limited circumstances).
You may revoke your authorization in writing at any time. This will not affect information already used or disclosed.

TELEHEALTH-SPECIFIC DISCLOSURES

– All telehealth services are conducted via secure, HIPAA-compliant platforms.
– With your consent, we may use email or text messages for appointment reminders, follow-ups, or non-urgent communications.
– You may request limitations on these communications.

YOUR RIGHTS

You have the right to:
– Inspect and request a copy of your medical records.
– Request corrections to your health information.
– Receive a list of certain disclosures we have made.
– Request confidential communications via alternative methods or locations.
– Request restrictions on certain uses or disclosures of PHI.
– Receive a paper or electronic copy of this Notice upon request.

REDISCLOSURE NOTICE

Information disclosed may be subject to redisclosure by the recipient and may no longer be protected by HIPAA.

CHANGES TO THIS NOTICE

We reserve the right to modify our privacy practices and this Notice at any time. The revised Notice will apply to all PHI we maintain, including information created before the changes. A current version will be posted on our website and available upon request.

COMPLAINTS

If you believe your privacy rights have been violated, you may contact our Privacy Officer at anna.heyda@fmassociates.org or file a complaint with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

You may be asked to sign a separate form acknowledging that you received this Notice.