HIPAA Authorization, Communication Consent & Privacy Acknowledgment

NOTICE OF PRIVACY PRACTICES

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

When this Notice refers to “we” or “us,” it means NewSelf Limited, its affiliated healthcare providers, pharmacists, and workforce members. We are required by law to maintain the privacy of your protected health information (“PHI”), provide you with this Notice, follow the terms currently in effect, and notify you in the event of a breach of unsecured PHI. We reserve the right to update this Notice and will make revised versions available as required.

1. AUTHORIZATION TO USE AND DISCLOSE PHI

By accepting this authorization, I permit NewSelf Limited, its providers, pharmacies, and authorized service providers to collect, use, and disclose my PHI for treatment, payment, and healthcare operations, including providing medical evaluations, prescribing and fulfilling medications, coordinating care, communicating with me, and managing services.

We may also use or disclose PHI as required or permitted by law, including public health reporting, regulatory oversight, law enforcement requests, judicial proceedings, research (where approved), and to prevent serious threats to health or safety.

2. TREATMENT, PAYMENT & HEALTHCARE OPERATIONS

We may use and disclose PHI for the following:

  • Treatment: Sharing information with pharmacists, providers, and care teams involved in your care
  • Payment: Billing, collections, eligibility verification, and payment processing
  • Healthcare Operations: Quality assurance, internal audits, compliance, performance evaluation, administrative activities, and business management

We may also contact you regarding prescription refills, treatment alternatives, and health-related services.

3. CUSTOMER SUPPORT, OPERATIONS & AI USE

You authorize NewSelf Limited to use your PHI for customer support and operational purposes, including responding to inquiries, resolving issues, assisting with prescriptions and orders, and managing your account.

Your information may be accessed by authorized personnel, including customer support, care coordination, and operations teams. We may also use automated systems, including AI-assisted tools, to review, categorize, and respond to communications, improve service quality, support training, prevent fraud, and manage disputes or chargebacks.

4. COMMUNICATION METHODS & RISKS

We may communicate with you via secure portal, email, SMS/text message, and telephone. While reasonable safeguards are used, some communication methods such as email and SMS are not fully secure. By providing your contact information and communicating through these channels, you acknowledge and accept these risks and understand that secure methods are recommended for sensitive information.

5. INCIDENTAL OR INADVERTENT DISCLOSURES

We maintain administrative, technical, and physical safeguards designed to protect your PHI in accordance with HIPAA. However, you acknowledge that incidental or inadvertent disclosures may occur despite reasonable safeguards, including through communication systems, human error, or technical limitations, and that such disclosures may occur as a byproduct of otherwise permitted uses.

6. DISCLOSURES TO FAMILY OR OTHERS

Unless you object, we may disclose relevant PHI to family members, relatives, or other individuals involved in your care or payment. If you are unavailable, we may use professional judgment to determine whether disclosure is in your best interest.

7. YOUR RIGHTS

You have the following rights regarding your PHI:

  • Request restrictions on use or disclosure (we may not always be required to agree)
  • Request confidential communications by alternative means or locations
  • Access, inspect, and obtain a copy of your PHI
  • Request amendments to your PHI
  • Receive an accounting of disclosures for up to six (6) years
  • Obtain a paper copy of this Notice
  • Opt out of certain communications such as fundraising

We will respond to requests as required by law and may charge reasonable fees where permitted.

8. RIGHT TO REVOKE

You may revoke this authorization at any time by submitting a written request to:

NewSelf Limited
30 N Gould St
Ste R Sheridan, WY 82801
legal@newself.com

Revocation will not apply to information already used or disclosed.

9. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint without retaliation with:

Privacy Officer, NewSelf Limited
or
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, D.C. 20201

Please Contact Us at 1-855-606-5232

Or Email Us at support@newself.com

NewSelf Limited LLC
is a technology platform that collaborates with independent healthcare professionals to deliver top-notch services through our NewSelf Patient Management System. We do not directly offer medical or pharmacy services, and payment does not guarantee that a prescription will be written or medication dispensed. Independent providers handle all medical services. The information provided on this site is for informational purposes only and is not a substitute for professional medical advice. For any health-related concerns, please consult your licensed healthcare provider. Our platform serves as an advertisement for services, not for specific medications.

NewSelf Limited LLC
30 N Gould St Ste R Sheridan WY 82801