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.
Balance Foot & Ankle PLLC, with offices in Howell and Bloomfield Township, Michigan. Effective October 1, 2026.
Your rights
You have the rights below over your health information. To use any of them, ask at either front desk or contact our Privacy Officer (details at the end of this notice).
- Get a 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 have about you. We will give it to you within 30 days of your request. If we need more time, we will tell you why in writing and take no more than 30 more days. We do not charge for copies.
- Ask us to correct your record. You can ask us to correct health information about you that you think is wrong or incomplete. We may say no, but if we do, we will tell you why in writing within 60 days (or, if we need more time, within 30 more days, and we will tell you so).
- Ask us to contact you privately. You can ask us to reach you in a certain way (for example, on your cell phone instead of your home phone) or to send mail to a different address. We will say yes to all reasonable requests, and we will not ask you why.
- Ask us to limit what we use or share. You can ask us not to use or share certain health information for your treatment, for payment or for running our practice. We do not have to agree, and we may say no if it would affect your care. If you pay for a service or item in full yourself, you can ask us not to share information about it with your health insurer for payment or our operations. We will say yes unless a law requires us to share it.
- Get a list of those we have shared your information with. You can ask for a list of the times we shared your health information in the six years before you ask, who we shared it with, and why. The list covers all sharing except for treatment, payment and running our practice, and a few other kinds (such as sharing you asked us to do). We will answer within 60 days, or tell you if we need up to 30 more days. One list every 12 months is free. If you ask for another within 12 months, we may charge a reasonable, cost-based fee, and we will tell you the amount first.
- Get a copy of this notice. You can ask for a paper copy of this notice at any time, even if you agreed to get it electronically.
- Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can use your rights and make choices about your health information. We will check that the person has this authority before we act.
- File a complaint if you believe your rights were violated. You can complain to us by contacting our Privacy Officer. You can also complain to the U.S. Department of Health and Human Services, Office for Civil Rights: online at www.hhs.gov/hipaa/filing-a-complaint, by phone at 1-877-696-6775, or by mail to 200 Independence Avenue, S.W., Washington, D.C. 20201. We will not retaliate against you for filing a complaint.
Your choices
In the cases below, you can tell us what you want us to share. Tell us your choice and we will follow it.
- Family, friends and others involved in your care. You can tell us whether we may share information with family, close friends or others involved in your care or in paying for it.
- Disaster relief. You can tell us whether we may share information in a disaster relief situation, for example to let your family know where you are.
If you cannot tell us your choice, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.
We never share your information for these purposes unless you give us written permission:
- Marketing
- Selling your information
- Most sharing of psychotherapy notes
How we use and share your information
We usually use or share your health information in these ways.
- To treat you. We use your health information and share it with other professionals who are treating you. Example: we send your visit notes and X-ray results to your primary care doctor, or to a surgeon or physical therapist we refer you to.
- To run our practice. We use and share your health information to run our practice, improve your care and contact you when needed. Example: we send appointment reminders by text or phone, and we review charts to check the quality of our care.
- To bill for your care. We use and share your health information to bill and get paid by health plans and others. Example: we give information about your visit to your health insurance plan so it will pay for your care.
Other ways we may use or share your information. The law allows or requires us to share your information in other ways, usually for purposes that serve the public good, such as public health and research. The law sets conditions we must meet before we share for these purposes.
- Public health and safety. For example, to prevent disease, help with product recalls, report reactions to medicines, report suspected abuse, neglect or domestic violence, or prevent or reduce a serious threat to anyone’s health or safety.
- Research. For health research, under the conditions the law sets.
- When the law requires it. We share information when state or federal law requires it, including with the U.S. Department of Health and Human Services if it asks to check that we are following federal privacy law.
- Organ and tissue donation. With organ procurement organizations.
- Medical examiners and funeral directors. With a coroner, medical examiner or funeral director when a person dies.
- Workers’ compensation, law enforcement and other government requests. For workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities the law authorizes; and for special government functions such as military, national security and presidential protective services.
- Lawsuits and legal actions. In response to a court or administrative order, or to a subpoena.
Substance use disorder treatment records. Records we receive about you from a program covered by 42 CFR Part 2 (the federal rules for substance use disorder treatment records) will not be used or shared in civil, criminal, administrative or legislative proceedings against you unless you give written consent, or a court orders it after you or the holder of the record has had notice and a chance to be heard, as 42 CFR Part 2 provides. A court order allowing use or sharing must come with a subpoena or other legal requirement compelling the disclosure before the record is used or shared.
Our responsibilities
- The law requires us to keep your health information private and secure, and to give you this notice of our legal duties and privacy practices.
- We will tell you promptly if a breach happens that may have put the privacy or security of your information at risk.
- We must follow the duties and privacy practices in this notice and give you a copy of it.
- We will not use or share your information in ways this notice does not describe unless you give us written permission. If you do, you can take it back at any time by telling us in writing. Taking it back does not undo anything we already did while we had your permission.
Changes to this notice
We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be posted at both offices and on our website, and you can ask us for a copy at any time.
Michigan law
Michigan law gives extra protection to some kinds of health information, including information about HIV/AIDS and some other serious communicable diseases, mental health treatment, and substance use disorder treatment. When Michigan law is stricter than federal law, we follow Michigan law.
Questions and where to find this notice
For questions about this notice, or to use any of your rights, contact:
Privacy Officer, Balance Foot & Ankle
4330 E Grand River Ave, Howell, MI 48843
Phone: (810) 206-1402
This notice is posted at the front desk of our Howell and Bloomfield Township offices and on our website, michiganfootdoctors.com. Ask at either front desk for a paper copy.