Effective date: April 19, 2024
Last updated: July 20, 2026
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.
This Notice applies to Revivex Healthcare, Inc., doing business as Pacific Pain & Wellness Group ("PPWG," "we," "us," or "our"), and the healthcare providers and workforce members who provide care through PPWG. We are required by law to maintain the privacy and security of protected health information, provide this Notice, and follow the duties and privacy practices described in the current Notice.
Your Rights
You have the rights described below regarding health information we maintain about you. Some rights are subject to legal limitations. Contact the Privacy Officer to exercise a right or ask a question.
Obtain a copy of your records
You may ask to inspect or receive an electronic or paper copy of your medical record, billing record, and other health information available under applicable law. We generally will provide a copy or summary within the time required by law. We may charge a reasonable, cost-based fee where permitted. If we deny access, we will explain why and whether the denial may be reviewed.
Ask us to correct your record
You may ask us in writing to correct health or billing information you believe is inaccurate or incomplete. We may deny the request in some circumstances, but we will explain the reason in writing and tell you about your right to submit a statement of disagreement.
Request confidential communications
You may ask us to contact you in a particular way or at a particular location. We will accommodate reasonable requests as required by law.
Ask us to limit what we use or share
You may ask us not to use or share certain health information for treatment, payment, or healthcare operations. We generally are not required to agree, except where the law requires us to do so. If you pay in full out of pocket for a healthcare item or service, you may ask us not to disclose information about that item or service to your health plan for payment or healthcare operations. We will agree unless disclosure is required by law.
Obtain an accounting of disclosures
You may ask for a list of certain disclosures of your health information made during the six years before your request. The accounting will not include disclosures that the law excludes, such as many disclosures for treatment, payment, healthcare operations, disclosures to you, and disclosures you authorized. We will provide one accounting in a 12-month period without charge and may charge a reasonable cost-based fee for additional requests.
Receive a copy of this Notice
You may request a paper copy at any time, even if you agreed to receive it electronically. The current Notice is also available in PPWG's Medical Information Privacy Practices.
Choose someone to act for you
If a person has legal authority to act for you, such as a healthcare power of attorney or legal guardian, that person may exercise your rights as permitted by law. We will verify the person's authority before acting.
File a complaint
You may complain to PPWG using the contact information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at 200 Independence Avenue SW, Washington, DC 20201, by calling 1-877-696-6775, or through the HHS complaint process. We will not retaliate against you for filing a complaint.
Your Choices
Where permitted by law and applicable to your care, you may tell us your choices about sharing information with family, friends, or others involved in your care; disaster-relief activities; and certain communications. If you cannot communicate your preference, such as during an emergency, we may share information when we believe it is in your best interest and the law permits it.
We generally need your written authorization before using or disclosing psychotherapy notes, using health information for certain marketing purposes, or selling health information, except where the law permits otherwise. You may revoke an authorization in writing at any time, except to the extent we already relied on it.
If PPWG contacts you for fundraising, you may tell us not to contact you again.
How We Typically Use and Share Health Information
Treatment
We may use and share health information with professionals involved in your treatment and care coordination.
Payment
We may use and share health information to bill and obtain payment from you, a health plan, or another responsible party.
Healthcare operations
We may use and share health information to operate our practice, improve care, train and evaluate our workforce, conduct quality and compliance activities, and manage services. We may use or disclose information that has been de-identified in accordance with applicable law.
Business associates
We may share health information with service providers that perform functions for PPWG when the information is necessary for those services. When a provider is a Business Associate, it must agree to safeguard the information and use or disclose it only as permitted by its agreement and law.
Appointment reminders and health-related communications
We may contact you about appointments, treatment, care coordination, alternatives, and health-related benefits or services as permitted by law. Tell us if you need communications sent in a different way or to a different location.
Other Uses and Disclosures Permitted or Required by Law
We may use or disclose health information when legal requirements are met for purposes including:
- public health and safety activities;
- reporting suspected abuse, neglect, or domestic violence;
- health oversight, licensing, audits, and investigations;
- responding to court or administrative orders and other lawful process;
- law-enforcement purposes permitted by law;
- preventing or reducing a serious and imminent threat to health or safety;
- workers' compensation and similar programs;
- research that satisfies applicable legal requirements;
- organ and tissue donation;
- coroners, medical examiners, and funeral directors;
- specialized government functions; and
- correctional institutions or custodial law enforcement where permitted by law.
We will not use or disclose health information for a purpose not described in this Notice unless you authorize it or the law otherwise permits or requires it.
Information Subject to Additional Protection
Federal and California law may provide additional protection for certain information, including mental-health records, substance-use-disorder records, psychotherapy notes, reproductive-health information, HIV/AIDS information, genetic information, communicable-disease information, sexual-assault or abuse information, and information concerning minors. We will follow the more protective law when it applies.
To the extent PPWG is a program subject to 42 CFR Part 2 or receives substance-use-disorder patient records protected by Part 2, those records may be used or disclosed only as permitted by applicable law and any controlling consent. A Part 2 record, or testimony describing information in that record, will not be used or disclosed in a civil, criminal, administrative, or legislative proceeding against the individual unless the individual provides specific written consent or a court issues an order and subpoena that satisfy applicable requirements. If fundraising communications use Part 2 information, we will provide the notice and choice required by law. A person may file a complaint concerning an alleged Part 2 violation with PPWG or the U.S. Department of Health and Human Services. Whether PPWG or a particular PPWG service is a Part 2 program depends on the applicable facts and law.
Our Responsibilities
We are required to:
- maintain the privacy and security of your protected health information;
- notify you promptly if a breach occurs that may have compromised the privacy or security of your information, as required by law;
- follow the duties and privacy practices described in the Notice currently in effect;
- provide a copy of this Notice upon request; and
- refrain from using or disclosing your information other than as described here unless you authorize it or law permits or requires it.
Changes to This Notice
We may change this Notice and make the revised Notice apply to health information we already maintain and information we receive in the future. When we make a material change, the revised Notice will be available upon request, at our office, and in PPWG's Medical Information Privacy Practices. Changes to this Notice are governed by applicable law and do not become effective merely because a person continues to use the Website.
Privacy Officer and Requests
Questions, complaints, and written requests to exercise your rights may be directed to:
Jessica Ramirez, Privacy Officer
Pacific Pain & Wellness Group
23150 Crenshaw Blvd #100
Torrance, CA 90505
Email: [email protected]
Phone: 310-437-7399