Notice of Privacy Practices

Effective Date: July 22, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Responsibilities

REVIVE Infusions & Wellness is required by law to:

• Maintain the privacy and security of your protected health information (PHI)
• Provide you with this Notice of Privacy Practices
• Notify you if a breach compromises the privacy or security of your PHI
• Follow the duties and privacy practices described in this notice

How We May Use and Disclose Your Health Information

Examples include:

• Treatment
• Payment
• Healthcare operations
• Appointment reminders
• Public health reporting
• Required by law
• Law enforcement
• Workers’ compensation
• Organ donation
• Research (when permitted)
• Business associates
• To avert a serious threat to health or safety

Uses Requiring Your Written Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes not otherwise permitted by law, including most:

• Marketing communications
• Sale of PHI
• Psychotherapy notes (when applicable)

You may revoke an authorization at any time in writing.

Your Rights

You have the right to:

• Receive a copy of your medical record
• Request corrections to your record
• Request confidential communications
• Request restrictions on certain disclosures
• Receive an accounting of disclosures
• Obtain a paper copy of this notice
• Choose someone to act on your behalf when legally authorized
• File a complaint if you believe your privacy rights have been violated

Our Duties

We are required by law to maintain the privacy of your health information and to notify affected individuals following certain breaches of unsecured protected health information.

Changes to This Notice

We reserve the right to change this Notice and make the revised Notice effective for all protected health information we maintain.

Complaints

If you believe your privacy rights have been violated, you may contact:

REVIVE Infusions & Wellness
250 NE Garden Valley Blvd., Suite 6
Roseburg, OR 97470
Phone: (541) 900-1112
Email: admin@reviveinfusewell.com

You may also file a complaint with:

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

You will not be retaliated against for filing a complaint.