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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0547067
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COMPLIANCE INFO
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Entry Properties
Last modified
5/4/2026 11:35:33 AM
Creation date
6/27/2023 9:39:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0547067
PE
4110 - BODY ART PRACTITIONER REGISTRATION
FACILITY_ID
FA0026687
FACILITY_NAME
REVIVE ME AESTHETICS (NGUYEN, MARY)
STREET_NUMBER
445
Direction
W
STREET_NAME
BEVERLY
STREET_TYPE
PL
City
TRACY
Zip
95376
CURRENT_STATUS
Inactive, non-billable
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
Site Address
445 W BEVERLY PL TRACY 95376
Tags
EHD - Public
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Clinical Outcome of Procedure(s) <br /> The results of your procedure are determined in part by nature of the pathology of skin type, but not <br /> limited to the following: <br /> Medications you are currently taking; your skin characteristics; personal pH balance of skin, tanning, <br /> fruitcaids, AHA's, and Retin A use; alcohol intake, smoking, sun exposure and improper skin care; <br /> following pre and post instructions. <br /> Initial I understand and accept such procedure is a process, often requiring a follow-up application <br /> of color to achieve desirable results and that 100%success is not guaranteed. <br /> Initial I acknowledge that obtaining permanent makeup is my choice alone, the application of <br /> permanent makeup will result a change in my appearance and that needles and pigments will go into my <br /> skin using only sterile disposable single use needles. No representations have been made to me as my <br /> ability to later restore the skin involved in permanent makeup to the original condition and can be costly <br /> to remove. <br /> Initial I acknowledge infection is always possible as a result of permanent makeup and I agree to <br /> follow all suggested instructions concerning the care of the site while it is healing. Possibilities may <br /> include: redness, minor bleeding, swelling, tenderness, allergic reaction, and/or keloid formation. <br /> Initial I understand that position of my procedures can be affected if I elect to have cosmetic <br /> surgery and/or cosmetic Botox and fillers. <br /> Initial I am aware that if I am to receive an MRI after the procedure, I must tell my healthcare <br /> professional that I have iron oxide permanent cosmetics. <br /> Initial I understand that this procedure is permanent in nature, but will fade over time. The fading <br /> can alter the original color and that this determines that it is time for touchups.Touchups can be done <br /> any time after 5-6 weeks.Then every two years as maintenance. <br /> Initial I agree to accompany my technician for blood testing in the event of accidental needle stick <br /> for their safety and disclose all test results to technician. <br /> Initial I understand that I must comply with recommended pre and post care and following it is <br /> crucial for the healing, preventing infection and results of treatment. <br /> Initial I understand that before and after pictures will be taken for purpose of documentation <br /> which may or may not be used for educational or advertising purposes. <br /> Initial I am over the age of 18 and not under any influence of drug or alcohol. <br /> Initial I am not pregnant. <br />
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