Notice of Privacy Practices

Revival Longevity & Wellness  ·  Winter Park, Florida  ·  Effective June 1, 2026

Effective Date: June 1, 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.

1. Our Commitment to Your Privacy

Revival Longevity & Wellness is required by law to maintain the privacy of your protected health information (PHI) and to provide you with this Notice of our legal duties and privacy practices. We are required to abide by the terms of this Notice currently in effect.

2. How We May Use and Disclose Your PHI

We may use and disclose your PHI for treatment, payment, and health care operations without your authorization. We may also disclose PHI as required by law, for public health activities, health oversight activities, judicial proceedings, law enforcement, and serious threats to health or safety. All other uses and disclosures require your written authorization.

3. Your Rights Regarding Your PHI

Right to Access Your PHI
You have the right to inspect and receive a copy of your PHI. We will respond to your request within 30 days.
Right to Request Amendment
If you believe PHI we have about you is incorrect or incomplete, you may request that we amend it.
Right to an Accounting of Disclosures
You have the right to receive a list of certain disclosures we have made of your PHI within the past six years.
Right to Request Restrictions
You may request that we restrict how we use or disclose your PHI for treatment, payment, or health care operations.
Right to Request Confidential Communications
You may request that we communicate with you about your PHI by alternative means or at alternative locations.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time.
Right to Notification of Breach
You have the right to receive notification if there is a breach of your unsecured PHI as required by the HIPAA Breach Notification Rule.

4. How to File a Complaint

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

U.S. Department of Health & Human Services
Office for Civil Rights  ·  1-877-696-6775
hhs.gov/ocr/privacy/hipaa/complaints

5. Contact Our Privacy Officer

Privacy Officer — Revival Longevity & Wellness
[Address — TBC], Winter Park, FL 32789
Phone: [Phone — TBC]
Email: [Email — TBC]

6. Effective Date and Revisions

This Notice is effective as of June 1, 2026. We reserve the right to revise this Notice at any time. Revised Notices will be available at our clinic, upon request, and at revivallongevitywellness.com/hipaa-notice.