Notice of Privacy Practices

Effective Date: March 1, 2026

Our Commitment to Your Privacy

RevitalizeMe Hyperbaric Oxygen Therapy & Wound Care ("RevitalizeMe") is required by federal and state law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of this Notice currently in effect.

Protected health information (PHI) is individually identifiable health information — including demographic information — that relates to your past, present, or future physical or mental health condition, the provision of healthcare to you, or the payment for that care.

How We May Use and Disclose Your PHI

The following describes the ways we may use and disclose your protected health information without your written authorization:

Treatment

We may use and disclose your PHI to provide, coordinate, and manage your healthcare and related services. This includes sharing information with your referring physician, other healthcare providers involved in your care, specialists, pharmacies, laboratories, and other entities necessary for your treatment. For example, your referring physician will receive progress reports about your hyperbaric oxygen therapy or wound care treatment.

Payment

We may use and disclose your PHI to obtain payment for healthcare services we provide to you. This may include submitting claims to Medicare, Medicaid, or your private insurance company, verifying insurance coverage, obtaining prior authorization, and billing activities. For example, we may share your diagnosis and procedure codes with your insurance plan to process a claim for hyperbaric oxygen therapy treatment.

Healthcare Operations

We may use and disclose your PHI for activities necessary to operate our practice and ensure quality care. These activities include quality assessment and improvement, staff training, credentialing, compliance programs, audits, and business management functions.

As Required by Law

We will disclose your PHI when required to do so by federal, state, or local law, including mandatory reporting obligations.

Public Health Activities

We may disclose your PHI for public health purposes, including reporting communicable diseases, reporting adverse events related to medical devices, and notifying individuals who may have been exposed to a communicable disease.

Health Oversight Activities

We may disclose your PHI to health oversight agencies for activities authorized by law, including audits, investigations, inspections, and licensure activities.

Abuse, Neglect, or Domestic Violence

We may disclose your PHI to appropriate government authorities if we reasonably believe you are a victim of abuse, neglect, or domestic violence, as required or authorized by law.

Judicial and Administrative Proceedings

We may disclose your PHI in response to a court order, subpoena, discovery request, or other lawful process, subject to applicable legal requirements.

Law Enforcement

We may disclose your PHI to law enforcement officials for certain law enforcement purposes as permitted or required by law, such as reporting certain types of wounds, injuries, or crimes.

Coroners, Medical Examiners, and Funeral Directors

We may disclose your PHI to a coroner, medical examiner, or funeral director as authorized by law.

Workers' Compensation

We may disclose your PHI as authorized by workers' compensation laws and similar programs that provide benefits for work-related injuries or illness.

Serious Threats to Health or Safety

We may use and disclose your PHI when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person.

Specialized Government Functions

We may disclose your PHI for military and veterans' activities, national security and intelligence activities, protective services for the President, and medical suitability determinations, as required by law.

Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice, including:

• Marketing communications (except face-to-face communications and promotional gifts of nominal value)
• Sale of your PHI
• Most uses of psychotherapy notes (if applicable)
• Any other use or disclosure not described in this Notice

You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on the authorization.

Your Rights Regarding Your PHI

You have the following rights with respect to your protected health information:

Right to Access

You have the right to inspect and obtain a copy of your PHI maintained by RevitalizeMe, including medical and billing records. You may request your records in electronic format. We will provide access within 30 days of your written request (or 60 days if an extension is necessary). Reasonable, cost-based fees may apply for copies.

Right to Amend

You have the right to request an amendment to your PHI if you believe it is incorrect or incomplete. We may deny the request under certain circumstances (e.g., if the information was not created by us, or if we determine the record is accurate). Any denial will be provided in writing with the reason for denial and your right to submit a statement of disagreement.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your PHI. This accounting does not include disclosures made for treatment, payment, or healthcare operations, or disclosures made with your authorization. The first accounting within a 12-month period is free; reasonable fees may apply for additional requests.

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to all restrictions, but we must comply with any agreed-upon restriction. We are required to agree to a restriction request if the disclosure is to a health plan for payment or healthcare operations purposes and the PHI pertains solely to a healthcare item or service for which you have paid out of pocket in full.

Right to Request 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 ask that we contact you only by mail or only at a specific phone number. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time, even if you have agreed to receive it electronically. You may request a copy by contacting our Privacy Officer.

Right to Be Notified of a Breach

You have the right to be notified if a breach of your unsecured PHI occurs. We will notify you in accordance with HIPAA Breach Notification requirements (45 CFR Parts 164.400-414) without unreasonable delay and no later than 60 calendar days after discovery of the breach.

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI
• We will notify you promptly if a breach occurs that may have compromised the privacy or security of your PHI
• We must follow the terms of this Notice currently in effect
• We will not use or disclose your PHI without your authorization, except as described in this Notice
• We will use the minimum necessary standard when using or disclosing PHI for purposes other than treatment
• We will not use or disclose your PHI for discriminatory purposes prohibited by law

Business Associates

We may share your PHI with third-party business associates who perform services on our behalf, such as billing, transcription, electronic health record hosting, and referral form processing. All business associates are required to sign a Business Associate Agreement (BAA) and are obligated to safeguard your PHI in accordance with HIPAA regulations.

Changes to This Notice

We reserve the right to change the terms of this Notice and make the new provisions effective for all PHI we maintain, including information created or received before the change. If we make a material change to this Notice, we will post the revised Notice on our website and make copies available at our facility.

Complaints

If you believe your privacy rights have been violated, you have the right to file a complaint. You will not be retaliated against for filing a complaint.

You may file a complaint with:

Our Privacy Officer

RevitalizeMe Hyperbaric Oxygen Therapy & Wound Care

Privacy Officer

3200 Cabaret Trail South, Suite 3
Saginaw, MI 48603

Phone: (989) 320-4434

Fax: (989) 256-0507

Email: connect@revitalizeme.com

U.S. Department of Health and Human Services

Office for Civil Rights

200 Independence Avenue, S.W.
Washington, D.C. 20201

Phone: (877) 696-6775