Revitalyfe Wellness
Effective Date: June 9, 2025
1. Purpose
This document identifies the licensed entities and supervising medical professional responsible for the clinical oversight of services provided by Revitalyfe Wellness. In compliance with California’s Corporate Practice of Medicine (CPOM) doctrine and applicable state licensing requirements, all medical and clinical services are provided under the supervision of a licensed physician.
2. Business Entity
Services are operated and delivered by Revitalyfe Wellness, a concierge mobile wellness company providing IV hydration therapy and vitamin injection services at client locations throughout its service area in the State of California.
Website: revitalyfewellness.com
Contact: info@revitalyfewellness.com | Phone: 707-812-1848 | Hours: Tuesday – Sunday, 9:00 AM – 7:00 PM (By appointment only)
3. Supervising / Medical Director Physician
All IV hydration therapy, vitamin injection services, and related clinical protocols offered by Revitalyfe Wellness are conducted under the supervision of a licensed Medical Director.
Medical Director:
[Medical Director Full Name, MD/DO]
License Number: [State Medical License #]
State of Licensure: California
Specialty: [Specialty]
Note: Provider identification details will be finalized and updated upon onboarding of the supervising physician. This document serves as the template disclosure to be completed prior to launch.
4. Scope of Supervision
The supervising physician is responsible for:
- Reviewing and approving all clinical service protocols, formulations, and intake criteria
- Establishing standing orders for IV therapy and injection services
- Reviewing client health intake screenings as required
- Providing clinical oversight for all services administered by qualified staff
- Being available for consultation and emergency guidance
5. Administering Providers
Services are administered by licensed and/or trained mobile healthcare professionals, which may include:
- Registered Nurses (RN)
- Licensed Vocational Nurses (LVN) operating under physician supervision
- Nurse Practitioners (NP) or Physician Assistants (PA) as applicable
All administering providers hold current, active licenses in the State of California and are credentialed per our internal protocols.
6. Regulatory Compliance
Revitalyfe Wellness operates in compliance with:
- California Business and Professions Code applicable to medical practice
- California’s Corporate Practice of Medicine (CPOM) doctrine
- California Medical Board regulations
- HIPAA (Health Insurance Portability and Accountability Act), where applicable
- California Confidentiality of Medical Information Act (CMIA)
7. Updates to Provider Information
This document will be updated promptly to reflect any changes in supervising physician, licensed entity, or provider credentials. The current version will be available upon request.
8. Contact
For questions about our provider structure or supervision arrangements: info@revitalyfewellness.com | 707-812-1848