Notice, Privacy and HIPPA

Effective Date: immediately
Recharge MedSpa & Wellness Clinic
Suite 200 • 6640 Cypresswood Dr. • Spring, TX 77379
📞 888-718-8186 | 🌐 www.RechargeWellnessClinic.com | ✉️ DrJo@RechargeMedSpas.com

This notice describes how your medical information may be used and disclosed, and how you can access this information. Please review it carefully.

You have the right to:

• Get a copy of your medical record.
  You may request to review or receive a paper or electronic copy of your health record.
   
• Ask us to correct your record.
  If you believe your record is incomplete or inaccurate, you may request a correction.
   
• Request confidential communications.
  You may ask us to contact you at a specific phone number, mailing address, or email.
   
• Ask us to limit what we use or share.
  You can request restrictions on how we use or disclose your information. While we may not always agree, we’ll honor your request when legally possible.
   
• Get a list of those with whom we’ve shared your information.
  You can ask for an accounting of disclosures made in the last six years (excluding certain exempt disclosures).
   
• Get a copy of this Notice.
  You may request a printed copy at any time, even if you agreed to receive it electronically.
   
• Choose someone to act for you.
  If you have given someone medical power of attorney or legal guardianship, that person can exercise your rights on your behalf.
   
• File a complaint.
  If you believe your privacy rights have been violated, you may file a complaint with:
   
  • Recharge MedSpa & Wellness Clinic Privacy Officer – DrJo@RechargeMedSpas.com
     
  • U.S. Department of Health & Human Services, Office for Civil Rights – www.hhs.gov/ocr/privacy
     

We will not retaliate against you for filing a complaint.

You can decide whether we may:

• Share information with family or friends involved in your care
   
• Share your information for public health and marketing purposes
   
• Include your name in appointment reminders or spa/wellness promotions
   

If you give us permission, you can change your mind at any time.

We may use and share your health information in the following ways:

To provide, coordinate, or manage your medical care.
Example: Sharing test results with a specialist or pharmacy.

To bill and receive payment from you or your insurance company.
Example: Submitting claims or verifying benefits.

To evaluate our clinic’s performance and improve services.
Example: Quality assurance, staff training, and accreditation reviews.

We may contact you by phone, text, or email to remind you of appointments or share information about treatment options.

We may share information to prevent disease, report adverse events, or comply with state/federal reporting requirements.

We may disclose information in response to court orders, subpoenas, or investigations when required by law.

We may share data with vendors (e.g., billing, labs, or software providers) who perform services for us under strict confidentiality and HIPAA-compliant agreements.

We are required by law to:

• Maintain the privacy and security of your protected health information (PHI)
   
• Provide you with this Notice and update it when changes occur
   
• Notify you promptly if a breach compromises your information
   
• Follow the terms of this Notice currently in effect

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

We may update this Notice at any time. The revised version will be posted in our office and on our website with a new effective date. All changes apply to information we already have as well as new information we collect.

If you have any questions about this Notice or your privacy rights, please contact:
Privacy Officer: Dr. Joyce M. Jackson
Email: DrJo@RechargeMedSpas.com
Phone: 888-718-8186
Mail: Recharge MedSpa & Wellness Clinic
Suite 200 • 6640 Cypresswood Dr. • Spring, TX 77379

7. Consent to Website/Written forms disclosure: By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.