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.
Effective Date: August 24, 2026
Our Commitment to Your Privacy
Forever Young Aesthetics, Inc. (“FYA,” “we,” “us,” or “our”) is required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this notice of our legal duties and privacy practices regarding your PHI, to notify you if a breach of your unsecured PHI occurs, and to follow the terms of this notice while it is in effect. This notice applies to health information created or received by FYA in the course of providing you services — including consultations, injectables, IV therapy, and skincare treatments — whether that information is kept in your chart, in our scheduling or billing systems, or elsewhere in our records.
We reserve the right to change this notice and to make the revised notice effective for PHI we already have as well as PHI we receive in the future. A current copy of this notice will always be available at our front desk and on our website, and you may request a copy at any time.
How We May Use and Disclose Your Health Information
The following categories describe the ways we may use and disclose your PHI. Not every possible use or disclosure is listed, but all the ways we are permitted to use and disclose information fall within one of these categories.
Uses and disclosures we may make without your written authorization
- We may use and share your PHI among our providers and staff (for example, a nurse injector, medical director, or esthetician) to provide, coordinate, or manage your treatment and any related services.
- We may use and share your PHI to bill and collect payment for services, including verifying insurance or HSA/FSA benefits where applicable, and communicating with payers or collection agencies.
- Health Care Operations. We may use and share your PHI to run our practice, including quality assessment, staff training, licensing, accreditation, business planning, and compliance activities.
- Business Associates. We may share your PHI with outside companies that perform services for us, such as billing, scheduling, or record-storage vendors. These business associates are required by written contract to protect your information.
- Appointment Reminders and Treatment Information. We may contact you by phone, text, email, or mail to remind you of appointments or to tell you about treatments, products, or health-related services that may interest you.
- Individuals Involved in Your Care. Unless you object, we may share relevant PHI with a family member, friend, or other person you identify as involved in your care or payment for your care.
- As Required by Law. We will disclose PHI when required to do so by federal, state, or local law.
- Public Health and Safety. We may disclose PHI for public health activities, such as reporting adverse reactions to products or medications, and to prevent or lessen a serious and imminent threat to the health or safety of you or others.
- Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
- Lawsuits, Disputes, and Law Enforcement. We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, and to law enforcement officials as required or permitted by law.
- Workers’ Compensation. We may disclose PHI to comply with workers’ compensation laws.
- Coroners, Medical Examiners, and Funeral Directors; Organ Donation. We may release PHI to a coroner or medical examiner, and to organizations that handle organ, eye, or tissue procurement or donation, as necessary.
- We may use or disclose PHI for research purposes only with your written authorization, or where an institutional review board or privacy board has approved a waiver of authorization consistent with law.
- Military, National Security, and Government Functions. If applicable, we may disclose PHI as required for military, veterans’, national security, or other specialized government functions.
Uses and disclosures that require your written authorization
- We will not use or disclose your PHI for marketing purposes, including any marketing communications where we receive payment from a third party, without your written authorization.
- Sale of Information. We will not sell your PHI without your written authorization.
- Psychotherapy Notes. We do not create or maintain psychotherapy notes.
- All Other Uses and Disclosures. Any use or disclosure of your PHI not described in this notice will be made only with your written authorization. You may revoke that authorization in writing at any time, except to the extent we have already relied on it.
Your Rights Regarding Your Health Information
- Right to Inspect and Copy. You may ask to inspect and receive a copy of your PHI that we use to make decisions about your care. We may charge a reasonable, cost-based fee for copies. In limited circumstances we may deny your request, and if so, you may ask that the denial be reviewed.
- Right to Amend. You may ask us to amend your PHI if you believe it is incorrect or incomplete. We may deny your request in certain circumstances, such as if the information was not created by us or is already accurate and complete.
- Right to an Accounting of Disclosures. You may ask for a list of certain disclosures we made of your PHI for purposes other than treatment, payment, and health care operations, and other than disclosures you already authorized.
- Right to Request Restrictions. You may ask us to restrict how we use or disclose your PHI for treatment, payment, or operations. We are not required to agree, except that we must agree to a restriction on disclosure to a health plan if the disclosure is for payment or operations (not treatment) and relates to a service you paid for yourself, in full, out of pocket.
- Right to Request Confidential Communications. You may ask us to contact you in a specific way (for example, a personal cell phone rather than a home number) or at a different location, and we will accommodate reasonable requests.
- Right to a Paper Copy of This Notice. You may ask us for a paper copy of this notice at any time, even if you agreed to receive it electronically.
- Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your PHI. We will confirm that a person has this authority before taking any action.
- Right to Be Notified of a Breach. We will notify you if a breach of your unsecured PHI occurs, as required by law.
- Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-800-368-1019, or online at www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.
Changes to This Notice
We reserve the right to change the terms of this notice at any time. Any revised notice will apply to PHI we already have as well as PHI we create or receive in the future, and will be effective as of the date shown on the revised notice. We will post the current notice at our practice location and make it available upon request.
Contact Information
Questions about this notice, or requests to exercise any of the rights described above, should be directed to:
Privacy Officer: Rick Young, CRNA Forever Young Aesthetics, Inc. 1205 N Franklin St Unit 111, Tampa, FL 33602 Phone: (813) 353-0023 · Email: info@foreveryoungtampa.com
This notice describes how we handle the health information of our patients. For information about how our website collects and uses visitor data, including cookies and advertising, see our Website Privacy Policy.
