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 ("Revival," "we," "our," or "us") 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 with respect to your PHI.

We are required to abide by the terms of this Notice currently in effect. We reserve the right to change the terms of this Notice at any time. Any revised Notice will apply to PHI we already have about you as well as any PHI we create or receive in the future. Revised Notices will be available in our clinic, upon request, and posted on our website at revivallongevitywellness.com/hipaa-notice.

2. What Is Protected Health Information?

Protected Health Information (PHI) is information about you — including demographic information — that may identify you and relates to your past, present, or future physical or mental health or condition, the provision of health care services to you, or the past, present, or future payment for the provision of health care services.

3. How We May Use and Disclose Your PHI

The following describes the ways we may use and disclose your PHI. Not every use or disclosure in a category will be listed. However, all uses and disclosures will fall within one of these categories.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your health care and any related services. For example, we may disclose your PHI to other physicians or health care providers who are involved in your care.

Payment

We may use and disclose your PHI to obtain payment for services we provide to you. For example, we may send your PHI to your health insurance plan to obtain reimbursement, or to determine your eligibility or coverage for health benefits.

Health Care Operations

We may use and disclose your PHI for health care operations necessary to run our practice and ensure that our patients receive quality care. For example, we may use your PHI to review the quality and competence of our staff and the treatment we provide.

Other Uses and Disclosures Permitted or Required by Law

We may also use or disclose your PHI for the following purposes without your authorization:

  • As required by law — where disclosure is required by federal, state, or local law
  • Public health activities — to report disease, injury, vital statistics, or child abuse/neglect as required by law
  • Health oversight activities — to government agencies for audits, inspections, investigations, or licensing purposes
  • Judicial and administrative proceedings — in response to a court order, subpoena, or other lawful process
  • Law enforcement — to a law enforcement official for certain law enforcement purposes as required or permitted by law
  • Serious threats to health or safety — to prevent or lessen a serious and imminent threat to health or safety
  • Coroners and medical examiners — for identification of a deceased person or determination of cause of death
  • Workers' compensation — to comply with workers' compensation laws
  • Military and veterans — if you are a member of the armed forces, as required by military command authorities
  • National security and intelligence — to authorized federal officials for national security activities

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures of your PHI not described above will be made only with your written authorization, including:

  • Most uses and disclosures of psychotherapy notes
  • Uses and disclosures for marketing purposes
  • Disclosures that constitute a sale of your PHI
  • Any other use or disclosure not described in this Notice

You may revoke any authorization you provide to us at any time, in writing, except to the extent that we have already taken action in reliance on that authorization.

4. Your Rights Regarding Your PHI

You have the following rights with respect to your PHI. To exercise any of these rights, you must submit a written request to our Privacy Officer at the contact information listed at the end of this Notice.

Right to Access Your PHI
You have the right to inspect and receive a copy of your PHI that we maintain in a designated record set. We may charge a reasonable fee for the cost of copying, mailing, or other supplies associated with your request. We will respond to your request within 30 days.
Right to Request Amendment
If you believe that PHI we have about you is incorrect or incomplete, you may request that we amend it. We may deny your request under certain circumstances. If we deny your request, we will provide you a written explanation and you may submit a statement of disagreement.
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. This right does not apply to disclosures made for treatment, payment, health care operations, or certain other disclosures.
Right to Request Restrictions
You may request that we restrict how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree to any restriction except: if you request that we restrict disclosure of your PHI to a health plan for payment or operations purposes, and you have paid for the service in full out-of-pocket, we must agree to that restriction.
Right to Request Confidential Communications
You may request that we communicate with you about your PHI by alternative means or at alternative locations. We will accommodate all reasonable requests. Please specify in writing how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you previously agreed to receive it electronically. You may request a copy at any of our clinic locations or by contacting us.
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.

5. Our Duties

We are required by law to:

  • Maintain the privacy of your PHI
  • Provide you with notice of our legal duties and privacy practices with respect to PHI
  • Notify you following a breach of unsecured PHI
  • Abide by the terms of the Notice currently in effect

6. Minimum Necessary Standard

When using or disclosing PHI or when requesting PHI from another covered entity or business associate, we will make reasonable efforts to limit PHI to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request.

7. Business Associates

We may share your PHI with third-party "business associates" that perform services on our behalf — such as billing companies, IT service providers, or transcription services. We require our business associates to appropriately safeguard your PHI through written Business Associate Agreements that comply with HIPAA requirements.

8. Florida State Law

Florida state law provides additional protections for certain categories of health information. Where Florida law provides greater privacy protections than HIPAA, we comply with Florida law. This includes additional protections for:

  • HIV/AIDS-related information (Florida Statute §381.004)
  • Mental health records (Florida Statute §394.4615)
  • Substance abuse treatment records (Florida Statute §397.501)
  • Genetic information

9. 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 or retaliated against for filing a complaint.

To file a complaint with Revival: Contact our Privacy Officer in writing using the information below.

To file a complaint with HHS Office for Civil Rights:

U.S. Department of Health & Human Services
Office for Civil Rights
200 Independence Avenue, SW
Washington, D.C. 20201
Toll Free: 1-877-696-6775
Website: hhs.gov/ocr/privacy/hipaa/complaints

10. Contact Our Privacy Officer

For questions about this Notice or to exercise your privacy rights, contact our Privacy Officer:

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

11. Effective Date and Revisions

This Notice is effective as of June 1, 2026. We reserve the right to revise this Notice at any time. The revised Notice will be effective for all PHI we maintain, including PHI created or received before the revision. Revised Notices will be available at our clinic, upon request, and at revivallongevitywellness.com/hipaa-notice.