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HIPAA NOTICE OF PRIVACY PRACTICE

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.

The words "Revitalis LLC" or "Revitalis" in this Notice describes the privacy practices of Revitalis LLC. This Notice also describes how Revitalis staff, volunteers, and trainees may use and share your information with Revitalis affiliated entities and Business Associates, which include, but are not limited to, associated physician groups, hospitals, ambulatory surgical centers, third-party medical billing agencies, and/or research collaborators. A list of these entities may be obtained by request at (480) 520.3223 or info@revitalismd.com.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. You may also ask for your test results directly from the labs where your tests are done. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
  • If your request is denied, we will explain the reasons, and tell you what your rights are.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say "yes" to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share (outside of Revitalis LLC) certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we have the option to say "no."
  • If you pay for a service or health care item out-of-pocket in full, you have the right to ask us not to share that information for the purpose of payment or our operations with your health insurer.

Choose someone to act for you

  • If you are unable to make health care decisions for yourself, and have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we allow them to make decisions for you.

Get a list of those with whom we've shared information (outside of Revitalis LLC)

  • You can ask for a list (accounting) of the times we have shared your health information during the six years prior to the date you request an accounting. We will respond to your request within 60 days.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make, disclosures made to you or your authorized representative, disclosures incidental to a use or disclosure that is otherwise permitted or required by law, and disclosures as excepted by law). We will provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this Privacy Notice

  • You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will promptly provide you with a paper copy.

Ask us to correct your medical record

  • You can ask us to correct health or billing information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say "no" to your request, for example, if your provider feels that the information currently in your record is complete and accurate. If we deny your request, we'll tell you why in writing within 60 days.
  • If we agree to your request, we will ask you to give us the names of the people you want to receive the corrected information.

File a complaint if you feel your privacy rights are violated

  • You can complain if you feel we have violated your privacy rights in person, or by mail or fax. You may obtain our contact information by telephone at (480) 520.3223, online at https://revitalismd.com/privacy-notice, or by mail at:
    7600 E Camelback Rd, Ste 7, Scottsdale, AZ, 85251
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/hipaa/filing-a-complaint/.
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. We will treat you the same no matter what choices you make.

In these cases, you have the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care.
  • Share information in a disaster relief situation.
  • If you are admitted to the hospital, your name, room location, general condition, and religion may be listed in that hospital's directory, based on hospital policy. This may be shared with members of your family, friends, members of the clergy, and to others who ask for you by name. You may ask the hospital to have your name taken off the directory list.
  • We may use your information for fundraising to support clinical and research organizations affiliated with Revitalis LLC in pursuit of its mission of excellence, but you can tell us not to contact you again. Information we may use is limited to demographic or other information allowed by law (such as name, address, telephone number or e-mail information, age, date of birth, gender, health insurance status, dates of service, department of service information, treating physician information, or outcome information).

If you are not able to tell us your preference – for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes.
  • Sale of your information.

Our Uses and Disclosures

How do we typically use or share your health information?

We have developed a shared electronic medical record for patient care that is used by:

  • Revitalis LLC staff and health care providers, researchers, third party billing agencies, electronic medical record technical support staff, and
  • Certain hospitals that are not members of Revitalis LLC, outpatient centers, affiliated researchers and research organizations, and community physicians.
  • Revitalis LLC may participate in health information exchanges (HIEs) and may use HIEs as a method to share, request, and receive electronic health information with other health care organizations.
Treat you

We can use your health information and share it with other professionals who are treating you both inside and outside of Revitalis LLC.
Example: Your Specialist may discuss your condition and treatment with your Primary Care Physician.

Run our organization

We can use and share your health information to run our clinician practices, improve your care, and contact you when necessary.
Example: We use health information about you for monitoring quality of care and teaching health care professionals.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.

Contact you

Revitalis LLC may use your health information to contact you at the address and telephone numbers you give to us.

How else can we use or share your health information?

We are allowed or required to share your information in other ways - usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations such as: Preventing disease; Helping with product recalls; Reporting adverse reactions to medications; Reporting suspected abuse, neglect, or domestic violence; Preventing or reducing a serious threat to anyone's health or safety.

Perform research

We can share health information about you for research that is approved by a Research Committee or its designee when written permission is not required by federal or state law. This also may include preparing for research or telling you about research studies in which you might be interested.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Address workers' compensation, law enforcement, and other government requests

We can use or share health information about you: For workers' compensation claims; For law enforcement purposes under specific conditions such as reporting when someone is the victim of a crime; With health oversight agencies for activities authorized by law; For special government functions such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena or other lawful process.

Medical Examiners and Funeral Directors

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Respond to Organ and Tissue Donation Requests

We can share health information about you with organ procurement organizations.

When do we need your written permission before sharing your health information?

We will not share your health information for other purposes not described in this Notice unless you give us your written permission. We are also restricted by state and other federal laws from sharing without your written permission certain types of health information that is considered highly sensitive.

Generally, we will ask for your consent before we share certain sensitive information such as:

  • Records of treatment received at federally funded substance use disorder programs
  • Certain psychotherapy documentation
  • HIV testing or test results
  • Genetic information
  • Confidential communications with a licensed Social Worker
  • Records from a Domestic Violence Victims Counselor or Sexual Assault Counselor

You may cancel an authorization or consent at any time in writing or, in certain limited situations, orally, except if we have already relied upon it.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this Notice and offer you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
  • We maintain hospital medical records for at least 7 years after your discharge or after your final treatment; other records are maintained in accordance with state and federal regulations.

De-identified Information

HIPAA expressly allows using health information to create de-identified information. The privacy principles described above do not apply to de-identified information. Health information is considered de-identified if (i) it does not identify an individual and (ii) there is no reasonable basis to believe it can be used to identify an individual. It is the practice of Revitalis LLC to use and/or disclose de-identified information where doing so is consistent with the role of an academic medical practice engaged in biomedomedical research and education.

How do we use de-identified information? We use de-identified information to support our patient care, biomedical research and education activities, some of which are conducted in collaboration with other academic institutions, foundations, organizations, government agencies, and commercial entities here in the U.S. and internationally. The de-identified information is also used to help us improve treatment options, reduce costs of care, improve administration of our health care operations, and advance public health initiatives.

Changes to the Terms of This Notice

We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request in registration areas, on our web site, or you can request a copy by contacting Revitalis LLC at (480) 520.3223.

WEBSITE & SMS COMMUNICATIONS POLICY

Introduction

At Revitalis LLC, we are committed to protecting your privacy. This section explains how we collect, use, and protect your personal information specifically regarding our website and SMS, MMS, or RCS communications.

1. Data Collection

We collect the following personal information when you submit your details on our website:

  • Contact Information: Name, email address, and phone number.
  • Website Interactions: Information about your activity on our site (e.g., pages visited).
  • Cookies: We may use cookies and similar tracking technologies to track activity on our Service and improve your experience.

2. Data Usage

The information we collect is used for:

  • Communication: Sending messages via SMS, MMS, or RCS related to appointments, inquiries, or services you requested.
  • Customer Support: Responding to your inquiries or requests.
  • Service Updates: Providing notifications about changes or updates to services.

3. Privacy & Data Sharing

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.

4. SMS Opt-In and Opt-Out

  • Opt-In: By submitting your phone number, you consent to receive messages via SMS, MMS, or RCS from Revitalis LLC related to appointments, updates, and other relevant information.
  • Opt-Out: You can cancel the messaging service at any time. Just text "STOP" to the short code. After you send the message "STOP" to us, we will send you a message to confirm that you have been unsubscribed. After this, you will no longer receive messages from us. If you want to join again, just sign up as you did the first time and we will start sending messages to you again.
  • Help: If you are experiencing issues with the messaging program you can reply with the keyword "HELP" for more assistance, or you can get help directly at info@revitalismd.com or +1 480.520.3223.

5. Types of Messages

If you provide consent, you may receive messages via SMS, MMS, or RCS such as:

  • Appointment Reminders: Notifications about scheduled appointments.
  • Service Updates: Information regarding inquiries or cases you have submitted.
  • Form Weblinks: Links to forms to enter information and submit documents.
  • Account Reminders: Notifications about outstanding balances on your account.

6. Fees, Frequency & Liability

  • Message frequency may vary based on your interaction with Revitalis.
  • Carriers are not liable for delayed or undelivered messages.
  • Message and data rates may apply for any messages sent to you from us and to us from you.

7. Security Disclaimer

Please be aware that standard messaging is not a secure means of communication. While we limit the amount of sensitive information sent via text, by opting in, you acknowledge that unauthorized third parties could potentially intercept these messages.

This Notice is effective as of January 1, 2026.