NOTICE OF PRIVACY PRACTICES
Effective date: 5/21/26
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.
Fox Aesthetics is committed to protecting the privacy of your health information. We are required by federal law — specifically the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations — to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. “Protected Health Information” (PHI) means information about you, including demographic information, that may identify you and that relates to your past, present, or future physical health, the provision of healthcare services to you, or payment for those services.
How We May Use and Disclose Your Health Information
The following describes the ways we may use and disclose your PHI. Not every use or disclosure will be listed, but all of the ways we are permitted to use and disclose information will fall within one of these categories.
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. For example, we may share your medical history and treatment information with your primary care physician, referring providers, or other healthcare professionals involved in your care. We may also share information with pharmacies for prescriptions or with laboratories for testing.
Payment
We may use and disclose your PHI so that treatment and services you receive may be billed to and payment collected from you, an insurance company, or a third party. For example, we may share information with your health insurer to obtain pre-authorization for a procedure, or to confirm coverage and process a claim.
HEALTHcare operations
We may use and disclose your PHI for healthcare operations necessary to run our practice and ensure quality care. This includes activities such as quality assessment, staff training and education, business management, compliance reviews, and customer service.
APPOINTMENT REMINDERS
We may contact you to remind you of upcoming appointments or follow-up care via phone, text message, email, or voicemail. If you prefer a different contact method, please let us know.
Treatment Alternatives And Health-Related Benefits
We may use and disclose your PHI to tell you about possible treatment options or alternatives, and about health-related products or services that may be of interest to you.
As required by law
We will disclose your PHI when required to do so by federal, state, or local law, including mandatory reporting requirements.
Public health activities
We may disclose your PHI for public health activities such as reporting communicable diseases, reporting adverse events related to products or treatments, or notifying persons who may have been exposed to a disease.
health Oversight activities
We may disclose PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure actions. This oversight is necessary for the government to monitor the healthcare system and government programs.
Judicial and Administrative Proceedings
We may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, subject to applicable legal protections.
Law Enforcement
We may disclose PHI for certain law enforcement purposes, including to identify or locate a suspect, report a crime on our premises, or respond to a court order or warrant.
Serious Threats to Health or Safety
We may use or disclose your PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of you or another person, or to the public.
Business Associates
We may share your PHI with third parties (“Business Associates”) that perform services on our behalf, such as billing companies, IT services, and administrative support. We require all Business Associates to sign a Business Associate Agreement committing them to protect your PHI in accordance with HIPAA.
Uses and Disclosures Requiring Your Authorization
Other uses and disclosures of your PHI not described above will be made only with your written authorization. This includes, but is not limited to:
• Most uses and disclosures of psychotherapy notes
• Uses and disclosures of PHI for marketing purposes
• Sale of your PHI
• Uses and disclosures not otherwise permitted by law
You may revoke any written authorization at any time, in writing. Your revocation will not affect any use or disclosure that occurred prior to the revocation.
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI maintained in our records, including your medical record and billing records. To request access, submit a written request to our Privacy Officer. We may charge a reasonable fee for copying. We may deny your request in limited circumstances; if denied, you may request a review of the denial.
Right to Request an Amendment
If you believe that your PHI is incorrect or incomplete, you may request that we amend the information. Submit your request in writing to our Privacy Officer, explaining why the information should be amended. We may deny your request if we determine the information is accurate and complete. You have the right to submit a statement of disagreement if your request is denied.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your PHI. This list will not include disclosures made for treatment, payment, healthcare operations, or disclosures you authorized. Submit your request in writing to our Privacy Officer. The first accounting per 12-month period is free; we may charge a reasonable fee for subsequent requests.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. You also have the right to request that we restrict disclosures to family members or others involved in your care. We are not required to agree to your requested restriction, except: we must agree to restrict disclosure of your PHI to a health plan if you pay for the service entirely out of pocket and the disclosure is for payment or operations purposes only.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information in a specific way or at a specific location. For example, you may ask that we contact you only at a certain phone number or by email. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Contact our office to request a copy.
Right to Be Notified of a Breach
You have the right to be notified in the event of a breach of your unsecured PHI. We will notify you without unreasonable delay and no later than 60 days after discovery of the breach, in accordance with HIPAA’s Breach Notification Rule.
Our Duties
Fox Aesthetics is required by law to:
• Maintain the privacy and security of your PHI
• Provide you with this Notice of our privacy practices
• Follow the terms of the Notice currently in effect
• Notify you in the event of a breach of your unsecured PHI
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. Changes will apply to PHI we already hold about you, as well as any PHI we receive in the future. We will post a revised Notice in our office and on our website, and will make the new Notice available upon request.
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
To file a complaint with Fox Aesthetics, contact our Privacy Officer:
Victoria Patze, RN — Privacy Officer
Fox Aesthetics LLC
5956 East Pima Street, Suite 120, Tucson, AZ 85712
(520) 336-8809 | victoria@thefoxaesthetics.com
To file a complaint with HHS:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W., Washington, D.C. 20201
Phone: 1-800-368-1019 | TDD: 1-800-537-7697
Website: www.hhs.gov/ocr/privacy/hipaa/complaints
This Notice is effective as of May 19, 2026.
By receiving services at Fox Aesthetics, you acknowledge that you have been offered
a copy of this Notice of Privacy Practices.