Notice of Privacy Practices

Effective Date: March 1, 2026

Last Updated: March 27, 2026

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.

At Summit Elite IV & Aesthetics, LLC (“Summit Elite,” “we,” “our,” or “us”), we understand that your health information is personal. We are required by law to maintain the privacy of your protected health information (“PHI”), provide you with this Notice of our legal duties and privacy practices, and notify affected individuals following a breach of unsecured protected health information when required by law. We are also required to follow the terms of the Notice currently in effect. 

This Notice explains:

  • How we may use and disclose your medical information
  • Your rights regarding your medical information
  • Our responsibilities related to protecting your medical information
  • How you may file a complaint if you believe your privacy rights have been violated

Your Rights

You have the right to:

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we maintain about you. Ask us how to do this.

We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee where permitted by law.

Ask us to correct your medical record

You can ask us to correct health information about you that you believe is incorrect or incomplete. We may say no to your request, but if we do, we will explain why in writing within the time required by law.

Request confidential communications

You can ask us to contact you in a specific way, such as at a different phone number, by email, or by mail to a different address. We will accommodate reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our healthcare operations. We are not required to agree to your request, and we may decline if it would affect your care.

If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or healthcare operations, and we will honor that request unless the law requires us to share the information.

Get a list of those with whom we have shared information

You can ask for an accounting of certain disclosures we made of your health information for up to six years before the date you ask, excluding disclosures for treatment, payment, healthcare operations, and certain other disclosures permitted by law.

We will provide one accounting each year at no charge. We may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this Notice

You can ask for a paper copy of this Notice 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 if someone is your legal guardian, that person may exercise your rights and make choices about your health information, to the extent permitted by law. We will verify that the person has this authority before taking action.

File a complaint if you believe your rights have been violated

You may complain to us if you believe we have violated your privacy rights. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint. These patient rights are reflected in the current HIPAA rule and HHS model notice. 

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us and we will follow your instructions where we are required to do so.

In these cases, you have both the right and choice to tell us to:


  • Share information with family members, close friends, or others involved in your care or payment for your care

  • Share information in a disaster relief situation

  • Include or exclude your information from communications or appointment coordination where another person may be involved


If you are not able to tell us your preference, for example if you are unconscious or incapacitated, we may share your information if we believe it is in your best interest.


Marketing and sale of information


We will not use or disclose your protected health information for marketing purposes, and we will not sell your protected health information, unless you give us your written authorization, except where permitted by law.


Our Uses and Disclosures


We typically use or share your health information in the following ways:


Treatment


We may use your health information and share it with other professionals who are treating you.


Example: A nurse, clinician, medical director, pharmacy, or other authorized healthcare professional may review your health history, treatment records, screening responses, medications, allergies, or follow-up notes in order to evaluate or provide services.


Payment


We may use and share your health information to bill and receive payment from health plans or other entities, where applicable.


Example: We may share information with a payer to obtain payment or determine coverage.


Healthcare operations


We may use and share your health information to run our practice, improve your care, support quality assurance, train staff, conduct audits, maintain licensure and compliance, and contact you when necessary.


Example: We may use information about you to review treatment quality, evaluate staff performance, maintain records, or improve operational processes.


Treatment, payment, and healthcare operations are core HIPAA-permitted uses and disclosures and are part of the current HHS model provider notice. 


How Else Can We Use or Share Your Health Information?


We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, public health, or safety, or that comply with the law. For these uses, we must meet many conditions in the law before we can share your information.


Help with public health and safety issues


We may share health information about you for certain public health and safety purposes, such as:


  • Preventing disease

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence where required or permitted

  • Preventing or reducing a serious threat to anyone’s health or safety


Comply with the law


We will share information about you if federal or state law requires it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.


Respond to organ and tissue donation requests


We may share health information about you with organ procurement organizations, when applicable.


Work with a medical examiner or funeral director


We may share health information with a coroner, medical examiner, or funeral director when an individual dies, as permitted by law.


Address workers’ compensation, law enforcement, and other government requests


We may use or share health information about you:


  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official in certain circumstances

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and protective services activities


Respond to lawsuits and legal actions


We may share health information about you in response to a court or administrative order, or in response to a subpoena, discovery request, or other lawful process when allowed by law.


These categories remain part of the HIPAA notice framework under the current regulation and HHS model materials. 


Uses and Disclosures Requiring Your Written Authorization


For uses and disclosures not described in this Notice, we will obtain your written authorization when required by law. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.


This generally includes:


  • Most uses and disclosures of psychotherapy notes, if applicable

  • Most marketing uses of PHI

  • Sales of PHI

  • Other uses and disclosures not otherwise permitted or required by law


Substance Use Disorder Records


Certain records related to substance use disorder treatment may be protected by additional federal confidentiality laws. If those laws apply to your information, we will handle those records in accordance with those requirements. HHS’s revised 2026 model notices reflect updates tied to 42 CFR Part 2. 


Our Responsibilities


We are required by law to:


  • Maintain the privacy and security of your protected health information

  • Provide you with this Notice of our legal duties and privacy practices

  • Follow the duties and privacy practices described in the Notice currently in effect

  • Notify you following a breach of unsecured protected health information when required by law


We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by notifying us in writing. HIPAA also requires a covered entity to designate a privacy official responsible for privacy policies and procedures. 


Changes to This Notice


We reserve the right to change this Notice, and the revised Notice will apply to all protected health information we maintain. The updated Notice will be available on our website and upon request.


If your website provides information about your services or benefits, HIPAA requires the notice to be prominently posted on the website. 


Complaints


If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below.


You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint. 


Contact Information


Summit Elite IV & Aesthetics, LLC

1062 General George Patton Rd

Nashville, TN 37221

615-200-7651

support@summiteliteiv.com


Privacy Contact:

Robert Coles, Chief Operations Officer

615-200-7651

robert@summiteliteiv.com