HIPAA Notice of Privacy Practices

You have certain rights regarding your health information.

1. Get a Copy of Your Medical Record You may ask to see or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We will provide access in accordance with applicable federal and New York State law. In certain circumstances, a reasonable, cost-based fee may apply.
2. Ask Us to Correct Your Medical Record If you believe information in your medical record is incorrect or incomplete, you may ask us to correct or amend it. We may deny your request in certain circumstances permitted by law. If we deny your request, we will explain the reason in writing and inform you of any additional rights available to you.
3. Request Confidential Communications You may ask us to contact you in a particular way or at a particular location. For example, you may ask us to call only a specific telephone number or send correspondence to a particular address. We will accommodate reasonable requests.
4. Ask Us to Limit What We Use or Share You may ask us not to use or disclose certain health information for treatment, payment, or health care operations. We are generally not required to agree to these requests. However, if you pay for a health care service or item in full out of pocket and ask us not to disclose information about that service or item to your health plan for payment or health care operations, we will comply with the request unless disclosure is otherwise required by law.
5. Get a List of Certain Disclosures You may request an accounting of certain disclosures of your PHI made during the period permitted by law. The accounting generally does not include disclosures made for treatment, payment, or health care operations or certain other disclosures excluded by law.
6. Get a Copy of This Notice You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.
7. Choose Someone to Act for You If you have given someone medical power of attorney or if someone is otherwise legally authorized to act on your behalf, that person may exercise your privacy rights as permitted by law. We may verify that the person has appropriate authority before taking action.
8. File a Complaint If you believe your privacy rights have been violated, you may file a complaint with ReVita Glow's management. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR). We will not retaliate against you or deny you treatment for filing a privacy complaint.

For certain health information, you may tell us your preferences about what we share.

Where applicable, you may tell us whether you want us to:

1. Share relevant information with family members, friends, caregivers, or others involved in your care or payment for your care.
2. Contact another person regarding your care when appropriate.
3. Share information for certain marketing or promotional purposes when authorization is required.
4. Use photographs, videos, testimonials, or other identifiable information for social media, advertising, promotional, or other non-treatment purposes.

If you are unable to tell us your preference—for example, during a medical emergency—we may share relevant information when permitted by law and when, in our professional judgment, doing so is in your best interest.

We typically use or disclose your health information in the following ways:

1. Treatment We may use and share your PHI to provide, coordinate, and manage your health care. For example, information may be shared among licensed professionals involved in your treatment or with an outside laboratory, pharmacy, consulting provider, or other health care professional involved in your care.
2. Payment We may use and disclose PHI to bill for services and receive payment. For example, we may provide necessary information to a payment processor, health plan, or other entity involved in payment for your services when applicable.
3. Health Care Operations We may use and disclose PHI in connection with the operation of our practice. Examples include quality assessment, staff training, credentialing, compliance activities, audits, business planning, patient safety activities, and reviewing the quality of services provided.
4. Business Associates We may disclose PHI to companies and individuals that perform services for us when those services require access to PHI. These may include electronic medical record providers, billing companies, laboratories, technology providers, secure communications providers, consultants, and other service providers. When required by HIPAA, these organizations are contractually required to appropriately safeguard your PHI.

We may use or disclose your PHI without your written authorization when permitted or required by law, including for certain:

1. Public Health and Safety Activities

We may disclose health information for legally authorized public health purposes, such as:

1. Preventing or controlling disease or injury
2. Reporting certain adverse events or product problems
3. Reporting suspected abuse or neglect when required or permitted by law
4. Preventing or reducing a serious threat to health or safety
5. Compliance With Law We may disclose PHI when federal, state, or local law requires us to do so.
6. Health Oversight Activities We may disclose information to authorized government agencies for activities such as audits, investigations, inspections, licensing, and regulatory oversight.
7. Judicial and Administrative Proceedings We may disclose PHI in response to a valid court or administrative order or other lawful legal process, subject to applicable privacy protections.
8. Law Enforcement We may disclose PHI to law enforcement officials when specifically permitted or required by law.
9. Workers' Compensation We may disclose PHI as authorized by and to the extent necessary to comply with workers' compensation or similar laws.
10. Coroners, Medical Examiners, and Funeral Directors We may disclose PHI when legally permitted or required for these purposes.

ReVita Glow promptly evaluates suspected unauthorized access, use, or disclosure of protected health information (PHI). When required by applicable law, affected individuals and appropriate regulatory authorities will be notified. We also take reasonable steps to limit potential harm and prevent similar incidents. If you believe your information may have been compromised or have questions about a possible privacy breach, please contact the management.

Certain categories of health information may receive additional protections under federal or New York State law. When applicable, we will comply with additional legal requirements governing the use and disclosure of specially protected information, which may include certain information concerning HIV/AIDS, mental health treatment, substance use disorder treatment, genetic information, and other information protected by applicable law. Where New York State law provides greater privacy protection than HIPAA, we will follow the more protective applicable requirement.

If you have questions about this Notice, want to exercise your privacy rights, or believe your privacy rights have been violated, please contact:

ReVita Glow Spa, LLC

Address: 2601 Ocean Parkway Suite L2

Brooklyn, NY 11235

Telephone: 917-994-6036

Email: [email protected]

You may also submit a complaint to:

U.S. Department of Health and Human Services Office for Civil Rights

Information about filing a HIPAA complaint is available through the U.S. Department of Health and Human Services Office for Civil Rights.

ReVita Glow Spa, LLC will not retaliate you against filing a complaint.

We reserve the right to change the terms of this Notice and our privacy practices as permitted by law. Changes may apply to PHI we already maintain as well as information we receive in the future. When we make a material change, the revised Notice will be made available upon request and, as applicable, at our office and on our website.

If you have questions about this Notice, please contact the management of ReVita Glow Spa, LLC

Address: 2601 Ocean Parkway Suite L2

Brooklyn, NY 11235

Telephone: 917-994-6036

Email: [email protected]