HIPAA Notice of Privacy Practices

Our commitment to your privacy

Revive Primary Care & Med Spa is required by law to maintain the privacy of your protected health information, to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

Protected health information means information that identifies you and relates to your past, present, or future health, treatment, or payment for care.

How we may use and disclose your health information

For treatment: we may use your health information to provide, coordinate, or manage your care, including sharing it with providers, nurses, technicians, and other personnel involved in your treatment.

For payment: we may use and disclose your health information so that treatment and services you receive may be billed to and payment collected from you, an insurance company, or a third party.

For health care operations: we may use your health information for quality assessment, staff review and training, licensing, and business activities necessary to operate the practice.

As required or permitted by law: we may disclose your health information when required by federal, state, or local law, including for public health activities, health oversight, judicial and administrative proceedings, law enforcement requests, and to avert a serious threat to health or safety.

Uses that require your written authorization

Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and any sale of protected health information require your written authorization. We will also obtain your written authorization before using before-and-after photographs or any identifiable image for promotional purposes.

You may revoke an authorization in writing at any time. A revocation does not affect disclosures already made in reliance on it.

Your rights regarding your health information

You have the right to inspect and obtain a copy of your medical and billing records, and to request that copy in electronic form where readily producible.

You have the right to request an amendment to information you believe is incorrect or incomplete. We may deny the request in certain circumstances and will explain the reason in writing.

You have the right to an accounting of certain disclosures of your health information, and to request restrictions on how we use or disclose it. If you pay for a service in full out of pocket, you may restrict disclosure of that service to your health plan.

You have the right to request confidential communications — for example, that we contact you at a specific phone number or address.

You have the right to be notified in the event of a breach of unsecured protected health information, and to receive a paper copy of this notice on request.

Appointment reminders and communications

We may contact you by phone, text message, email, or mail with appointment reminders, follow-up instructions, or information about treatment alternatives and health-related services that may be of interest to you. You may ask us to limit or change how we contact you.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the practice's Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

As supplied by the practice, this notice also directs complaints to the State of Texas Medical Board. This appears to be template text carried over from another document, since the practice operates in Florida. It is shown here unchanged and is pending confirmation or correction by the practice.

Changes to this notice

We reserve the right to change this notice and to make the revised notice effective for health information we already have as well as any information we receive in the future. The current notice will be posted in the office and on this website with its effective date.

Contact the Privacy Officer

Privacy Officer: Samona Altman. Email: mgmt@revivepcms.com. You may also raise a privacy question in person at the Lutz office or by calling the practice during business hours.