[columnize id=”” class=”” style=””]This notice describes how medical information about you may be used and disclosed and how you can get access to this health information. Please review it carefully.


We understand that information about you and your health is personal. We are committed to protecting your health information. We will create a personal record of the care and services you receive at REVITA Medical Wellness Center. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and disclose your health information. We also describe your rights and certain obligations we have regarding the use and disclosure of your health information


Make sure that health information that identifies you is kept private.
Give you this notice of our legal duties and privacy practices with respect to your health information.
Follow the terms of the notice that is currently in effect.

The notice describes the practices of REVITA Medical Wellness Center and that of any health care professional authorized to enter information into your medical record, including medical staff, all departments and units of REVITA Medical Wellness Center, all employees, staff, volunteers, and other personnel.


Treatment- Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment- Your health information may be used as necessary to support the day-to-day activities and management of REVITA Anti-Aging. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law Enforcement-Your health information may be disclosed to law enforcement agencies without your permission, to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.

Public Health Reporting- Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain conditions, reactions or communicable disease to the State’s Public Health Department:

  1. To prevent or control disease, injury or disability.
  2. To report reactions to medications or problems with products.
  3. To notify people of recalls of products they may be using.
  4. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
  5. To notify the appropriate government authority if we believe an adult patient has been the victim of abuse, neglect, or domestic violence.
  6. We will only make this disclosure if you agree or when required or authorized by law.
  7. Special Situations-Military and Veterans: If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

Lawsuits and Disputes-If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.

Blood Testing-While you are undergoing exams, a health care worker may accidentally be exposed to blood or other body fluids. If this occurs, your blood will be tested for the presence of certain diseases (for example, HIV, Hepatitis viruses). This is necessary to help protect the health care worker. The results of these tests will be a part of your medical record and will not be released except with your prior consent or as required by law.


Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use of disclosure of your information, you may submit a written revocation. However, your decision to revoke the authorization will not affect or undo any use of disclosure of information that occurred before you notified us of your decision.

North Carolina Law – In the event that North Carolina Law requires us to give more protection to your health information than stated in this notice or required by Federal law, we will give that additional protection to your health information.


REVITA Medical, PC is required by law to maintain the privacy of your protected health information and to provide you with this Notice of Privacy Practices. We are required to abide by the privacy policies and practices that are outlined in this notice.


You have certain rights under the Federal privacy standards. These include:

  1. The right to request restrictions on the use and disclosure of your protected health information.
  2. The right to receive confidential communications concerning your medical condition and treatment.
  3. The right to inspect and copy your protected health information.
  4. The right to amend or submit corrections to your protected health information.
  5. The right to receive an accounting of how and to whom your protected health information has been disclosed.
  6. The right to receive a printed copy of this notice.


Appointment reminders – Your health information will be used by our staff for appointment reminders.

Information About Treatments – Your health information may be used to send you information on any recommended procedures or treatments relevant to the management of your medical condition. We may also send you information describing other health-related goods and services that we believe may be of interest to you.

Changes to this Notice:

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you, as well as any information we receive in the future. The notice will contain the effective date on the last page. We will post a copy of the current Notice of Privacy Practices at 7810 Ballantyne Commons Parkway, Suite 200, Charlotte, NC 28277.

Complaints may be filed with CMS in two ways:

  1. By Internet using the Administrative Simplification Enforcement Tool at http://htct.hhs.gov/.
  2. By mail at:

The Centers for Medicare & Medicaid Services, HIPAA TCS
Enforcement Activities, P.O. Box 8030
Baltimore, MD 21244-8030