Last Updated: November 25, 2025
PRIVACY POLICY
This notice describes the practices of Sculpt Aesthetics (the “Practice”) and its staff with respect to your protected health information maintained by the practice.
This notice will tell you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. Please review this Notice carefully.
1. Your Health Information Rights
Although your health record is the physical property of Practice, the information belongs to you. You have the right to:
•Request a restriction on certain uses and disclosures of your information for treatment, payment and health care operations. However, we are not required by law to agree to a requested restriction, unless the request relates to a restriction on disclosures to your health insurer regarding health care items or services for which you have paid out of pocket and in full;
•Obtain a paper copy of this notice from Sculpt Aesthetics;
•Inspect and/or get an electronic or paper copy of your medical record. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
•Request that we amend your health record as provided by law. We will notify you if we are unable to grant your request to amend your health record within 60 days of your request;
•Obtain an accounting of disclosures of your health information as provided by law. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months; and
•Request communication of your health information by alternative means or at alternative locations. We will accommodate reasonable requests.
You may exercise your rights set forth in this notice by providing a written request to Sculpt Aesthetics, 1230 N 1st Street, Hamilton, MT 59840.
2. Uses and Disclosures of Medical Information That Do Not Require Your Authorization
The following categories describe different ways that we may use and disclose medical information without your authorization. We will explain what we mean for each category of uses or disclosures, but not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information without your authorization should fall within one of the categories.
We will use your health information for treatment.
•For example: We may disclose medical information about you to doctors, nurses, technicians, medical students or other personnel who are involved in taking care of you. We may share medical information about you in order to coordinate different treatments, such as prescriptions and lab work.
We will use your health information to bill for services.
•For example: We may use and share your health information to bill and receive payment for services we provide.
We will use your health information for regular health care operations.
•For example: We may use the information in your health record to assess the care and outcome in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.
We will use and disclose your health information as otherwise allowed by law. Examples of those uses and disclosures follow:
•Business associates: There are some services provided in our organization through agreements with business associates. Examples include answering services and copy services. To protect your health information, however, we require business associates to appropriately safeguard your information.
•Communications regarding treatment alternatives and appointment reminders: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
•Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, medications, devices, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.
•Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
•Abuse, neglect or domestic violence: As required by law, we may disclose health information to a governmental representative authorized by law to receive reports of abuse, neglect or domestic violence.
•Judicial, administrative and law enforcement purposes: Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes.
•Health oversight activities: We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure.
•Threats to health or safety: We may use or disclose health information as allowed by law if we believe in good faith that it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or for law enforcement authorities to identify or apprehend an individual involved in a crime.
•Special government functions: We may disclose health information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law, or for protective services to the President of the United States or certain other government officials. If you are a member of the military, we may disclose health information to military authorities under some circumstances. If you are an inmate of a jail, prison or other correctional facility or in the custody of law enforcement personnel, we may disclose health information necessary to maintain your health and the health and safety of others.
•Required or allowed by law: We will disclose medical information about you when required or allowed to do so by federal, state or local law.
3. Our Responsibilities
In addition to the responsibilities set forth above, we are also required to:
•Maintain the privacy and security of your health information;
•Subject to certain exceptions under the law, provide notice of any unauthorized acquisition, access, use or disclosure of your protected health information, to the extent it was not otherwise secured;
•Abide by the terms of this Notice; and
•Notify you if we are unable to agree to a requested restriction on certain uses and disclosures.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain, including information created or received before the change. Should our information practices change, we are not required to notify you, but we will have the revised notice available upon your request at Sculpt Aesthetics.
4. When We Need Your Written Authorization
We will not use or disclose your health information without your written authorization, except as described in this notice. Additional circumstances that might require your additional written authorization are not common, but an example would be uses and disclosures for marketing purposes.
5. Contact Us
If you have questions or would like additional information, you may contact Sculpt Aesthetics at (406) 961-9700.
If you believe your privacy rights have been violated, you can send a complaint to Sculpt Aesthetics at 1230 N 1st Street, Hamilton, MT 59840. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. There will be no retaliation for filing a complaint.
This notice is effective on the following date: January 19, 2023.
We may change our policies and this notice at any time and have those revised policies apply to all the protected health information we maintain. If or when we change our notice, we will post the new notice at the office of each practice location where it can be seen and on our website.
