HIPAA Notice of Privacy Practices

Revival IV Hydration, LLC ("Revival IV," "we," "us," or "our") is committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, or healthcare operations, and for other purposes permitted or required by law.

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your Protected Health Information
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of the Notice currently in effect
• Notify you if we are unable to agree to a requested restriction
• Notify you in the event of a breach of your unsecured PHI

What is Protected Health Information (PHI)?

Protected Health Information includes any individually identifiable health information we collect from you or create in the course of providing services, including:

• Personal identifiers (name, address, phone number, email)
• Health conditions, symptoms, and medical history
• Medications and allergies
• Treatment and services provided
• Payment and billing information
• Health assessment results and recommendations

How We May Use and Disclose Your PHI

1. For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your IV therapy and wellness services. This includes:

• Consultation and assessment of your health needs
• Administration of IV therapy and wellness treatments
• Coordination with your other healthcare providers (with your permission)
• Follow-up care and monitoring
• Sharing information with third-party vendors who provide scheduling, appointment management, or other treatment-related services on our behalf

Example: Our nurse may review your medical history to determine the most appropriate IV therapy formulation for your needs. We may also use a third-party scheduling system to manage your appointments and send you appointment reminders.

2. For Payment

We may use and disclose your PHI to bill and receive payment for services provided, including:

• Processing credit card or other payment transactions
• Providing receipts for HSA/FSA reimbursement
• Collection activities for unpaid balances

3. For Healthcare Operations

We may use and disclose your PHI for business operations necessary to run our practice and ensure quality care, including:

• Quality assessment and improvement activities
• Training of staff and healthcare professionals
• Business planning and development
• Professional licensing and credentialing
• Compliance and regulatory activities

4. Business Associates

We may disclose your PHI to third-party service providers (Business Associates) who perform services on our behalf, such as:

• Billing and payment processing
• Electronic health record systems
• Legal and consulting services
• Website hosting and IT support

These Business Associates are required by law to protect your PHI and may only use it for the purposes we specify.

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures of your PHI require your written authorization, including:

• Marketing purposes: We will not use or disclose your PHI for marketing without your permission
• Sale of PHI: We will never sell your PHI
• Psychotherapy notes: Not applicable to our services
• Other purposes: Any other use or disclosure not described in this Notice

You may revoke your authorization at any time by providing written notice, except to the extent we have already acted based on your authorization.

Uses and Disclosures Without Authorization

We may use or disclose your PHI without your authorization in the following situations:

• Required by Law: When disclosure is required by federal, state, or local law
• Public Health Activities: To prevent or control disease, injury, or disability
• Health Oversight Activities: To government agencies for audits, investigations, or inspections
• Judicial and Administrative Proceedings: In response to court orders or subpoenas
• Law Enforcement: To law enforcement officials for specific purposes (e.g., reporting crimes)
• To Avert Serious Threat: To prevent a serious threat to health or safety
• Organ Donation: To organizations involved in organ, eye, or tissue donation and transplantation
• Workers' Compensation: As required by workers' compensation laws
• Military and National Security: For armed forces personnel or national security purposes
• Coroners and Funeral Directors: To identify deceased persons or determine cause of death

Your Rights Regarding Your Health Information

1. Right to Inspect and Copy

You have the right to inspect and receive a copy of your medical records and other health information. To request access, contact us at (573) 557-9066. We may charge a reasonable fee for copying and mailing costs.

Note: We may deny your request in certain limited circumstances. If denied, you may request a review of the denial.

2. Right to Amend

If you believe your health information is incorrect or incomplete, you may request an amendment. We may deny your request if:

• The information was not created by us
• The information is not part of our records
• The information is accurate and complete

3. Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or healthcare operations. The first accounting within a 12-month period is free; subsequent requests may incur a reasonable fee.

4. Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request except in limited circumstances (e.g., disclosure to a health plan for services you paid for in full out-of-pocket).

5. Right to Request Confidential Communications

You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. For example, you may request we contact you only by phone or mail to a specific address. We will accommodate reasonable requests.

6. 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. Contact us to request a paper copy.

7. Right to Notification of a Breach

You have the right to be notified if your unsecured PHI is breached.

Changes to This Notice

We reserve the right to change this Notice and make the new Notice effective for all PHI we maintain, including information created or received before the change. We will post the current Notice on our website with the effective date. You may request a copy of the current Notice at any time.

Complaints

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 (HHS).

File a Complaint with Us:

File a Complaint with HHS:

You will not be penalized or retaliated against for filing a complaint.

Questions or More Information

If you have questions about this Notice or need more information about our privacy practices, please contact: