Effective Date: June 1, 2025 | Last Updated: June 1, 2025
This notice describes how medical information about you may be used and disclosed by New Horizon Functional Medicine, and how you can access this information. Please review it carefully.
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get a copy of your medical record
You can request a copy or summary (electronic or paper) of your medical record and other health information we have about you. We will respond within 30 days. A reasonable, cost-based fee may apply.
Ask us to correct your medical record
If you believe the health information we have is incorrect or incomplete, you may request a correction. We may decline your request with a written explanation.
Request confidential communications
You can ask us to contact you in specific ways (e.g., home vs. mobile) or to send mail to a different address. We will honor all reasonable requests.
Ask us to limit what we use or share
You may request we not use or share certain health information for treatment or practice operations. While we are not required to agree, we will consider all requests. If you pay in full out-of-pocket for a service, you may request that we not share related information with your insurer. We will honor this unless required by law.
Get a list of certain disclosures
You may request a list (accounting of disclosures) of who we’ve shared your information with in the past six years, excluding those made for treatment, practice operations, or those you authorized. One free report is available annually. A reasonable fee may apply for additional requests.
Get a copy of this notice
You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
Choose someone to act for you
If you have given someone medical power of attorney or they are your legal guardian, that person may exercise your rights and make choices about your information.
File a complaint if you believe your rights were violated
You may contact the office of New Horizon Functional Medicine directly at health@newhorizonfm.com or 423-468-0326.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201 or 1-877-696-6775.
We will not retaliate against you for filing a complaint.
YOUR CHOICES
For certain types of information, you have the right and choice to tell us how to share it:
- Share with family, close friends, or others involved in your care
- Share information in a disaster relief situation
If you are unable to communicate your preferences, we may share your information when, in our professional judgment, it is in your best interest.
We will never share your information without written consent for:
- Marketing purposes
- Sale of your information
DISCLOSURES OF HEALTH INFORMATION
We will not disclose your protected health information to any individual, organization, or third party not directly involved in your care without your written authorization, unless required or permitted by law.
We may share your information, without additional written consent, with:
- Laboratories and diagnostic testing facilities
- Supplement or specialty pharmacies (when applicable)
- EMR, telehealth, and scheduling platforms used to deliver care
- Other healthcare professionals directly involved in your treatment
These uses are considered necessary for treatment, care coordination, and practice operations.
You may request a written accounting of other disclosures made without your authorization. This includes certain public health, legal, or safety-related disclosures. We will provide one report per year free of charge; additional reports may incur a reasonable fee.
HOW WE TYPICALLY USE YOUR INFORMATION
We may use and disclose your information to:
Treat you
Coordinate care and services with other healthcare professionals.
Run our practice
Maintain operations, improve care quality, and contact you when needed.
Manage payment
Although we are a cash-pay only practice and do not bill insurance, we may use your information for billing or internal record-keeping related to payment.
OTHER PERMITTED DISCLOSURES
We may also share your information as required by law or for the following:
- Reporting disease, adverse reactions, or abuse
- Responding to legal actions (court orders, subpoenas)
- Assisting with organ donation or medical examiner inquiries
- Complying with government and public health requests
- Responding to law enforcement or workers compensation inquiries
- Assisting with national security or presidential protection services
OUR RESPONSIBILITIES
- Maintain the privacy and security of your protected health information
- Notify you promptly of any data breach that may affect you
- Follow the terms of this notice and provide you with a copy
- Not use or share your information beyond what is described here without your written authorization (you may revoke such authorization at any time)
CHANGES TO THIS NOTICE
We reserve the right to modify this notice. Updates will apply to all existing and future information we maintain. The latest version will be posted in our office and on our website.
New Horizon Functional Medicine 