NOTICE OF PRIVACY PRACTICES

Effective Date: October 1, 2025 (Updated for 2026 Compliance)  

The Well Woman Functional Medicine, PLLCTHIS 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.Your health information is private. The Well Woman Functional Medicine, PLLC (“Practice”) is required by law to maintain the privacy of your protected health information (“PHI”), provide you with this Notice of Privacy Practices (“Notice”), and notify you promptly if a breach occurs that may compromise the privacy or security of your information.We will not use or disclose your health information except as described in this Notice or as permitted or required by law. This Notice applies to all records of your care created or maintained by Practice.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

TreatmentWe may use or disclose your health information to provide, coordinate, or manage your healthcare. This includes sharing information with physicians, specialists, nurses, labs, or other healthcare providers involved in your care.PaymentWe may use or disclose your information to obtain payment for services, verify insurance coverage, process claims, or coordinate benefits. This may include information such as diagnoses, procedures, or treatment notes.Healthcare OperationsWe may use or disclose your information for practice operations, such as quality improvement, training, auditing, accreditation, or administrative purposes.Business AssociatesWe may share your information with third‑party vendors (“business associates”) who assist us with services such as billing, transcription, legal services, accounting, or electronic health record support. Business associates are required by law to safeguard your information.Regulatory Agencies and Public HealthWe may disclose information to public health authorities or government agencies as required to prevent or control disease, report adverse events, or comply with audits or inspections.Workers’ CompensationWe may disclose information as authorized to comply with workers’ compensation laws.Military, National Security, and Law EnforcementIf you are a member of the armed forces or involved in national security activities, we may disclose information as required by military command or federal authorities. We may also disclose information to law enforcement when required by law.InmatesIf you are incarcerated or in custody, we may disclose information necessary for your care or for the safety of the facility.Organ and Tissue DonationWe may disclose information to organizations involved in organ or tissue procurement.Medical Examiners and Funeral DirectorsWe may disclose information to coroners, medical examiners, or funeral directors as needed.Required by LawWe will disclose information when required by federal, state, or local law, including responding to court orders, subpoenas, or legal processes.Other UsesAny other uses or disclosures not described in this Notice will be made only with your written authorization.

SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER (SUD) INFORMATION

(Required under HIPAA + 42 C.F.R. Part 2 Final Rule)Certain health information related to substance use disorder diagnosis, treatment, or referral is protected by federal law (42 C.F.R. Part 2). These records have stricter confidentiality requirements.We will not disclose SUD‑related information without your written consent unless permitted by law.Recipients of SUD‑related information are prohibited from redisclosing it unless allowed by federal law.If a request for your records involves SUD‑related information, we may require a written attestation confirming that the information will not be used or disclosed unlawfully.SUD‑related information is subject to HIPAA breach‑notification rules.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

Right to Confidential CommunicationsYou may request that we contact you in a specific way (e.g., at work, by mail) or at a specific location.Right to Inspect and CopyYou may review or obtain a copy of your medical record, including electronic copies.Right to AmendYou may request an amendment to your record if you believe it is incorrect or incomplete.Right to an Accounting of DisclosuresYou may request a list of certain disclosures made in the past six years.Right to Request RestrictionsYou may request restrictions on how we use or disclose your information. We are not required to agree except when:The disclosure is for payment or healthcare operations, andYou paid out‑of‑pocket in full for the service.Right to Additional Protections for SUD InformationIf any of your records are protected under 42 C.F.R. Part 2, you have additional rights regarding consent, redisclosure, and accounting of disclosures.Right to a Paper or Electronic Copy of This NoticeYou may request a paper or electronic copy at any time.Right to Choose Someone to Act for YouA legal guardian or medical power of attorney may exercise your rights.Right to Revoke AuthorizationYou may revoke any authorization you previously provided, except where we have already acted in reliance on it.Requests to exercise these rights must be submitted in writing to:The Well Woman Functional Medicine, PLLC  88 Nashua Road Apt RLondonderry, NH 03053Phone: 603‑537‑6444

STATE LAWS MORE RESTRICTIVE THAN HIPAA (NEW HAMPSHIRE)

Medical Record RetentionWe maintain medical records for at least seven (7) years after your last visit, or until age nineteen (19) for minors.Health Information Privacy Act (HIPA)New Hampshire law requires written consent before your electronic health records are shared with any third party not involved in your care.Breach NotificationWe will notify you promptly of any unauthorized access to your protected health information as required by New Hampshire law.

LAW ENFORCEMENT REQUESTS AND ATTESTATION REQUIREMENTS

(Required under new HIPAA + Part 2 alignment rule)Certain requests for your health information—especially those involving SUD‑related information—require the requesting party to provide a written attestation confirming that the information will not be used or disclosed unlawfully. We may deny requests that do not meet federal or state legal requirements.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions or would like additional information, contact our office at 603‑537‑6444.If you believe your privacy rights have been violated, you may file a complaint with:The Well Woman Functional Medicine, PLLC  Phone: 603‑537‑6444and/or with the U.S. Department of Health and Human Services Office for Civil Rights:Phone: 1‑800‑368‑1019Online: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsfEmail: OCRComplaint@hhs.govMail:Centralized Case Management Operations  U.S. Department of Health and Human Services200 Independence Avenue, S.W.Room 509F HHH BuildingWashington, D.C. 20201We will not retaliate against you for filing a complaint.

CHANGES TO THIS NOTICE

Practice reserves the right to change the terms of this Notice and make the new provisions effective for all PHI we maintain. Updated versions will be available upon request and posted on our website.