Effective Date: September 10, 2026

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.

Alliance Functional Medicine is committed to protecting the privacy and security of your health information. This Notice of Privacy Practices explains how we may use and disclose your protected health information, your rights regarding that information, and our responsibilities under applicable federal and state privacy laws.

This notice applies to Alliance Functional Medicine, its healthcare providers, workforce members, contractors, and business associates when they are permitted to access protected health information while performing services on our behalf.

YOUR RIGHTS

You have the following rights regarding the health information we maintain about you.

Get a Copy of Your Health Information

You may request an electronic or paper copy of your medical record and other health information we maintain about you. We will provide a copy or summary within the time required by law. We may charge a reasonable, cost-based fee when permitted by law.

Ask Us to Correct Your Health Information

You may ask us to correct health information that you believe is incorrect or incomplete. We may deny your request in certain circumstances, but we will provide a written explanation when required by law.

Request Confidential Communications

You may ask us to contact you in a specific way or at a particular location. For example, you may request that we use a particular telephone number, email address, or mailing address. We will accommodate reasonable requests.

Ask Us to Limit What We Use or Share

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations. We are not generally required to agree to every request.

If you pay for a healthcare service or item in full and ask us not to disclose information about that service or item to a health plan for payment or healthcare operations, we will honor the request unless disclosure is required by law.

Receive an Accounting of Disclosures

You may request a list of certain disclosures of your health information made during the six years before your request. The list will not include every disclosure, such as disclosures made for treatment, payment, healthcare operations, or disclosures you specifically authorized.

We will provide one accounting during any 12-month period without charge. We may charge a reasonable fee for additional requests during the same period.

Get a Copy of This Notice

You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically. A current copy is also available on our website.

Choose Someone to Act for You

If you have given someone medical power of attorney or another person is legally authorized to act on your behalf, that person may exercise your rights and make choices regarding your health information. We will verify the person's authority before taking action.

File a Complaint

You may file a complaint with Alliance Functional Medicine if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a complaint or exercising your privacy rights.

YOUR CHOICES

For certain health information, you may tell us how you want that information shared.

Family, Friends, and Others Involved in Your Care

You may tell us whether we may share relevant information with family members, friends, caregivers, or others involved in your care or payment for your care.

If you are unable to communicate your preference, we may share information when we determine that doing so is in your best interest and is permitted by law.

Disaster Relief

We may share relevant information with an organization assisting with disaster relief efforts so that family members or others responsible for your care may be notified about your condition or location.

Marketing and Sale of Information

We will obtain your written authorization before using or disclosing your protected health information for most marketing purposes or selling your protected health information.

Alliance Functional Medicine does not sell patient health information.

Fundraising

If we contact you for fundraising purposes, you may tell us not to contact you again. Alliance Functional Medicine does not currently use patient health information for fundraising activities.

Other Uses Requiring Authorization

Most uses and disclosures of psychotherapy notes, when applicable, require written authorization. Other uses or disclosures not described in this notice will generally be made only with your written authorization.

You may revoke an authorization in writing at any time. Revocation will not affect actions already taken in reliance on the authorization.

HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

Treatment

We may use and disclose your health information to provide, coordinate, and manage your healthcare.

Example: Your provider may review your medical history, medications, symptoms, laboratory results, or records from another healthcare professional when evaluating your condition and developing a care plan.

Payment

We may use and disclose your health information to bill and receive payment for services provided to you.

Example: We may share information with a health plan, payment processor, or billing service to determine eligibility, obtain authorization, submit a claim, or collect payment.

Healthcare Operations

We may use and disclose your health information to operate our practice, improve services, train staff, conduct quality reviews, manage business activities, and contact you when necessary.

Example: We may review patient records to evaluate the quality and effectiveness of our services or to improve patient care.

Business Associates

We may share protected health information with vendors and service providers that perform functions on our behalf, such as electronic health record hosting, telehealth technology, electronic prescribing, billing, payment processing, secure communications, data storage, or technical support.

When required, these organizations must enter into agreements requiring them to appropriately protect protected health information.

Appointment Reminders and Care Communications

We may use your contact information to send appointment confirmations, reminders, follow-up instructions, care coordination messages, or information about treatment alternatives and health-related services that may interest you.

Public Health and Safety Activities

We may disclose health information for public health and safety purposes when permitted or required by law. These purposes may include:

Preventing or controlling disease

Reporting certain illnesses or injuries

Reporting suspected abuse, neglect, or domestic violence

Reporting adverse reactions to medications or medical products

Assisting with product recalls

Preventing or reducing a serious and imminent threat to health or safety

Research

We may use or disclose health information for approved research when the research meets applicable legal requirements. Certain research activities may require your written authorization.

Compliance With the Law

We may disclose your health information when federal or state law requires us to do so. This may include disclosures to the U.S. Department of Health and Human Services when it is investigating our compliance with federal privacy laws.

Organ and Tissue Donation

We may disclose health information to organ procurement organizations or other entities involved in organ, eye, or tissue donation and transplantation when applicable.

Medical Examiners and Funeral Directors

We may disclose health information to a coroner, medical examiner, or funeral director when legally authorized and necessary for that individual to perform their duties.

Workers' Compensation

We may disclose health information as authorized by and necessary to comply with workers' compensation laws or similar programs.

Law Enforcement and Legal Proceedings

We may disclose health information for certain law enforcement purposes, court proceedings, administrative proceedings, health oversight activities, or other legally authorized requests.

We will verify the authority and legal requirements associated with a request before disclosing protected health information.

National Security and Correctional Institutions

We may disclose health information for authorized national security activities or to correctional institutions and law enforcement officials when permitted by law.

Reproductive Healthcare Privacy

We will not use or disclose protected health information for the purpose of conducting a criminal, civil, or administrative investigation into, or imposing liability on, a person for seeking, obtaining, providing, or facilitating reproductive healthcare when the healthcare was lawful under the circumstances in which it was provided.

For certain requests involving reproductive healthcare information, the requesting party may be required to provide a signed attestation stating that the information will not be used for a prohibited purpose.

Information Disclosed to Other Parties

Information lawfully disclosed to another person or organization may no longer be protected by the HIPAA Privacy Rule after disclosure. Other federal or state privacy laws may continue to protect the information.

OUR RESPONSIBILITIES

Alliance Functional Medicine is required by law to:

Maintain the privacy and security of protected health information

Provide you with this Notice of Privacy Practices

Follow the privacy practices described in the notice currently in effect

Notify affected individuals when a breach may have compromised the privacy or security of their protected health information

Limit uses, disclosures, and requests to the minimum necessary information when required by law

Provide access to health information and honor other patient rights as required by law

We will not use or disclose your health information for purposes not described in this notice unless you provide written authorization or the use or disclosure is otherwise permitted or required by law.

ELECTRONIC COMMUNICATIONS AND TELEHEALTH

Alliance Functional Medicine may provide services using secure electronic health records, telehealth technology, electronic prescribing, patient portals, email, text messaging, and other electronic communication systems.

We use reasonable administrative, technical, and physical safeguards intended to protect your information. However, no electronic communication system can be guaranteed to be completely secure.

Please use the secure patient portal for medical questions, records, symptoms, medications, treatment information, and other sensitive health information whenever available.

Do not submit urgent medical concerns or detailed medical information through ordinary email, website contact forms, social media, or marketing text messages.

If you believe you are experiencing a medical emergency, call 911 or go to the nearest emergency department.

CHANGES TO THIS NOTICE

Alliance Functional Medicine may change the terms of this notice and make the revised notice effective for all protected health information we maintain, including information created or received before the revision.

When material changes are made, we will update the notice on our website and make the revised version available upon request. The effective date shown at the top of the notice indicates when the current version became effective.

QUESTIONS, REQUESTS, OR COMPLAINTS

To ask a question, exercise a privacy right, request a copy of this notice, or submit a privacy complaint, contact:

Privacy Officer

Alliance Functional Medicine
[email protected]
https://alliancefunctionalmed.com

Please do not include medical details or urgent health concerns in an ordinary email.

You may also file a complaint with:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Telephone: 1-877-696-6775

Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/

Alliance Functional Medicine will not retaliate against you for filing a complaint or exercising any right described in this notice.