Effective Date: February 2025
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.
Our Commitment to Your Privacy
Reviv Beauty Med Spa is committed to protecting your health information. We are required by law to:
- Maintain the privacy of your protected health information (PHI)
- Provide you with this Notice of our legal duties and privacy practices
- Follow the terms of this Notice currently in effect
- Notify you if a breach of your unsecured health information occurs
What is Protected Health Information (PHI)?
Protected Health Information includes any information about your health, the healthcare services you receive, and payment for those services that can be linked to you. This includes:
- Your name, address, phone number, email, and date of birth
- Medical history, diagnoses, and treatment records
- Photographs taken before and after treatment
- Payment and billing information
- Appointment records and communications
How We May Use and Disclose Your Health Information
Uses and Disclosures That Do Not Require Your Authorization
For Treatment: We may use and share your health information with healthcare professionals involved in your care. For example, your provider may share information with a consulting physician or specialist.
For Payment: We may use and share your health information to bill and collect payment for services. For example, we may share information with your insurance company or financing provider to obtain payment.
For Healthcare Operations: We may use and share your health information for our business operations, such as quality improvement, staff training, and business management.
As Required by Law: We may disclose your health information when required by federal, state, or local law.
Public Health Activities: We may disclose your health information for public health purposes, such as reporting communicable diseases or adverse reactions to medications.
Health and Safety: We may use or disclose your health information to prevent a serious threat to your health or safety or that of others.
Legal Proceedings: We may disclose your health information in response to a court order, subpoena, or other lawful process.
Law Enforcement: We may disclose your health information to law enforcement officials under certain limited circumstances.
Coroners and Medical Examiners: We may disclose your health information to coroners, medical examiners, and funeral directors as required by law.
Workers’ Compensation: We may disclose your health information for workers’ compensation claims.
Uses and Disclosures That Require Your Written Authorization
We will obtain your written authorization before using or disclosing your health information for purposes not described in this Notice, including:
- Marketing: We will not use your health information for marketing purposes without your written authorization.
- Sale of Information: We will not sell your health information without your written authorization.
- Before and After Photographs: We will obtain your written consent before using your photographs for marketing, social media, or our website.
- Psychotherapy Notes: If applicable, we will obtain your authorization before disclosing psychotherapy notes.
You may revoke your authorization at any time by submitting a written request to our Privacy Officer. Revocation will not affect any disclosures made before we received your revocation.
Your Rights Regarding Your Health Information
Right to Access
You have the right to inspect and obtain a copy of your health information maintained by us. To request access, submit a written request to our Privacy Officer. We may charge a reasonable fee for copying and mailing.
Right to Amend
You have the right to request that we amend your health information if you believe it is incorrect or incomplete. Submit your request in writing to our Privacy Officer, explaining why the amendment is needed. We may deny your request under certain circumstances.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your health information. Submit a written request to our Privacy Officer specifying the time period (up to six years prior to the request).
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request, except that we must agree to restrict disclosures to a health plan for services you paid for in full out of pocket.
Right to Confidential Communications
You have the right to request that we communicate with you about your health information in a specific way or at a specific location. For example, you may request that we contact you only at your work phone number. We will accommodate reasonable requests.
Right to a Paper Copy
You have the right to obtain a paper copy of this Notice upon request, even if you previously agreed to receive it electronically.
Electronic Communications
We may communicate with you via email and text message for appointment reminders, treatment follow-ups, and other healthcare communications. Please be aware that email and text messaging are not fully secure methods of communication. By providing your email address and phone number, you acknowledge this risk and consent to electronic communications.
If you prefer that we not communicate with you electronically, please notify our Privacy Officer in writing.
How We Protect Your Information
We maintain administrative, technical, and physical safeguards to protect your health information, including:
- Patient records are stored in Boulevard, a HIPAA-compliant electronic health records system
- Access to patient information is limited to authorized personnel
- Staff receive training on privacy and security practices
- Physical records (if any) are stored in locked cabinets
- Computer systems are password-protected
Breach Notification
In the event of a breach of your unsecured health information, we will notify you as required by law. Notification will include a description of the breach, the types of information involved, steps you can take to protect yourself, and what we are doing to investigate and mitigate the breach.
Changes to This Notice
We reserve the right to change this Notice and make the new provisions effective for all health information we maintain. If we make material changes, we will post the revised Notice on our website and make copies available at our office.
Privacy Officer
Our Privacy Officer is responsible for ensuring compliance with this Notice and addressing your privacy concerns:
Privacy Officer: Kristen-Anne Thomas, FNP-BC
Address: 104 S Park Ave Suite 3, Sanford, FL 32771
Phone: (407) 534-9178
Email: info@revivbeauty.com
Filing a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:
Reviv Beauty Med Spa Attention: Privacy Officer
104 S Park Ave Suite 3
Sanford, FL 32771
Phone: (407) 534-9178
Email: info@revivbeauty.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr
You will not be retaliated against for filing a complaint.
Acknowledgment
You will be asked to sign an acknowledgment that you received this Notice of Privacy Practices. If you decline to sign, we will still provide treatment, but we will document that the acknowledgment was not obtained.
Reviv Beauty LLC 104 S Park Ave Suite 3
Sanford, FL 32771
Phone: (407) 534-9178
Email: info@revivbeauty.com
Website: revivbeauty.com
This Notice is effective as of February 2025 and will remain in effect until replaced. 
