Effective Date: September 17, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION, AND YOUR RIGHTS REGARDING YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice applies to protected health information created or maintained by Performance Edge Physical Therapy (“Performance Edge PT,” “we,” “our,” or “us”) in connection with physical therapy and related healthcare services.

PRIVACY CONTACT

Privacy Officer: Dr. Mishka Spencer, PT, DPT
Performance Edge Physical Therapy
Address: 38099 Schoolcraft Rd. Suite 105 Livonia, MI 48150
Telephone: (734) 210-1447
Email: [email protected]
Website: performanceedgept.com

Questions, privacy requests, and complaints may be directed to the Privacy Officer using the contact information above.

YOUR RIGHTS

You have the following rights regarding your health information.

1. Obtain an electronic or paper copy of your record

You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information maintained by Performance Edge PT.

We will generally provide the requested information within 30 days after receiving your request. We may charge a reasonable, cost-based fee as permitted by law. In limited circumstances, we may deny access to certain information. If access is denied, we will explain the reason in writing and tell you whether the decision may be reviewed.

1. Ask us to correct your record

You may ask us to correct health information that you believe is inaccurate or incomplete. We may deny the request in certain circumstances, but we will explain the denial in writing, generally within 60 days.

1. Request confidential communications

You may ask us to communicate with you in a particular way or at a particular location. For example, you may ask us to use a specific telephone number, email address, mailing address, or communication method.

We will accommodate reasonable requests. You are responsible for providing accurate contact information and notifying us when it changes.

1. Ask us to limit what we use or disclose

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations. We are not generally required to agree to your request. If we agree, we will comply unless the information is needed to provide emergency treatment or disclosure is otherwise required by law.

If you pay for a service completely out of pocket, you may ask us not to disclose information about that service to your health plan for payment or healthcare operations. We will honor that request unless disclosure is required by law.

1. Obtain a list of certain disclosures

You may request a list, called an “accounting of disclosures,” showing certain disclosures of your health information made during the six years before your request.

The accounting will not include every disclosure. For example, it generally will not include disclosures made for treatment, payment, healthcare operations, disclosures made directly to you, or disclosures that you specifically authorized.

We will provide one accounting in a 12-month period without charge. We may charge a reasonable, cost-based fee for additional requests during the same period after notifying you of the anticipated cost.

1. Obtain a copy of this Notice

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically. A current copy is also available at our clinic and, when applicable, on our website.

1. Choose someone to act for you

If you have given another person legal authority to make healthcare decisions or exercise privacy rights for you, such as through a healthcare power of attorney or legal guardianship, we will recognize that person’s authority after verifying it as required by law.

For minors, a parent or legal guardian generally acts as the minor’s personal representative, subject to exceptions under applicable law.

1. File a complaint

You may complain to Performance Edge PT if you believe your privacy rights have been violated. Submit the complaint to the Privacy Officer using the contact information at the beginning of this Notice.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Telephone: 1-877-696-6775
Website: https://www.hhs.gov/hipaa/filing-a-complaint

Performance Edge PT will not retaliate against you for asking questions, exercising your privacy rights, or filing a complaint.

YOUR CHOICES

For certain health information, you may tell us your preferences about what we disclose.

1. Family members, friends, and others involved in your care

You may tell us whether we may share relevant information with a family member, friend, caregiver, or another person involved in your care or payment for your care.

If you are unable to communicate your preferences, we may disclose limited relevant information when we reasonably believe it is in your best interest and the disclosure is permitted by law.

1. Disaster-relief situations

We may disclose limited information to an organization assisting with disaster relief so that family members or others responsible for your care can be notified about your location, condition, or safety.

1. Marketing, testimonials, photographs, and promotional content

We will obtain your written authorization before using or disclosing your protected health information for marketing when HIPAA requires authorization.

We will obtain separate permission before using identifiable patient photographs, videos, testimonials, treatment stories, or similar information for advertising, social media, educational promotion, or other public-facing purposes. Declining such permission will not affect your treatment.

We do not sell your protected health information.

1. Fundraising

Performance Edge PT does not currently use protected health information for fundraising. If this practice changes, we will provide any notices and opt-out rights required by law.

USES AND DISCLOSURES FOR WHICH WRITTEN AUTHORIZATION IS GENERALLY NOT REQUIRED

1. Treatment

We may use and disclose your health information to evaluate, coordinate, provide, and manage your care.

Examples include:

• Reviewing your medical history, symptoms, examination findings, goals, and treatment progress;
• Creating and updating your physical therapy plan of care;
• Communicating with referring or treating physicians and other healthcare professionals;
• Obtaining or sharing relevant records with another provider involved in your care;
• Coordinating care, referrals, consultations, and discharge planning;
• Sending requested progress reports to providers involved in your treatment; and
• Using electronic health-record, documentation, scheduling, intake, outcome-measure, exercise-program, or secure communication systems to support your care.

1. Payment

We may use and disclose your information to obtain payment for services and administer billing-related activities.

Examples include:

• Submitting claims, supporting documentation, certifications, recertifications, or other required information to Medicare, a Medicare contractor, a secondary payer, or another responsible payer;
• Verifying benefits or coverage when applicable;
• Responding to payment inquiries, claim reviews, audits, appeals, or medical-necessity requests;
• Preparing itemized receipts, superbills, or other documents requested by you;
• Communicating with billing services, payment processors, collection services, or financial institutions as permitted by law; and
• Collecting patient balances and administering payment plans.

When you request a superbill or other reimbursement document, the document may contain diagnosis, treatment, provider, and payment information. You are responsible for deciding whether and how to submit that document to your insurer or another third party.

1. Healthcare operations

We may use and disclose your health information to operate and improve Performance Edge PT.

Examples include:

• Quality assessment and improvement;
• Reviewing provider performance and documentation;
• Compliance, licensing, credentialing, auditing, and legal services;
• Business planning, accounting, and administrative activities;
• Patient-safety and risk-management activities;
• Training and supervision;
• Evaluating patient experience and service quality;
• Maintaining, supporting, securing, backing up, or troubleshooting electronic systems;
• Scheduling, intake, workflow management, and patient follow-up; and
• Detecting or preventing fraud, misuse, or security incidents.

1. Business associates and technology service providers

We use outside companies and professionals to perform services on our behalf. These may include:

• Electronic medical-record and practice-management providers;
• Online intake-form, scheduling, and patient-portal providers;
• Customer-relationship-management and patient-communication platforms;
• Billing, coding, eligibility, claims, and Medicare-support services;
• Payment processors;
• Information-technology, cybersecurity, data-hosting, and backup providers;
• Accounting, legal, consulting, and compliance professionals; and
• Document storage, destruction, mailing, or other administrative vendors.

These parties may receive or access health information only to the extent necessary to perform services for Performance Edge PT or as otherwise permitted by law. When HIPAA requires it, we enter into a Business Associate Agreement requiring the party to appropriately safeguard protected health information.

Performance Edge PT currently uses systems such as Spry for clinical and practice-management functions and PT Marketing Machine for certain intake, scheduling, communication, follow-up, and administrative functions. The particular systems we use may change over time. Our use of any system that creates, receives, maintains, or transmits protected health information is subject to our privacy and security obligations and, where required, an appropriate Business Associate Agreement.

1. Appointment reminders and communications about care

We may contact you by telephone, voicemail, text message, email, patient portal, or mail regarding:

• Appointments and scheduling;
• Intake forms;
• Waitlist status;
• Treatment instructions;
• Home programs;
• Billing or payment matters;
• Records requests;
• Follow-up regarding your care; and
• Other health-related services that may be relevant to you.

Electronic communication may involve privacy risks, particularly if another person has access to your telephone, email account, voicemail, or electronic device. You may request a different or more confidential method of communication.

Your communication preferences and any separate consent to receive automated or marketing messages are addressed separately from this Notice. This Notice itself does not constitute consent to receive marketing messages or automated communications when separate consent is required.

1. Public health and safety

We may disclose health information as permitted or required by law for activities such as:

• Preventing or controlling disease or injury;
• Reporting adverse events or product problems;
• Reporting suspected abuse, neglect, or domestic violence;
• Preventing or reducing a serious and imminent threat to health or safety; and
• Complying with public-health reporting requirements.

1. Compliance with law and health oversight

We may disclose information when federal or state law requires it, including disclosures to the U.S. Department of Health and Human Services to demonstrate compliance with federal privacy law.

We may disclose information to authorized health-oversight agencies for audits, investigations, inspections, licensing, disciplinary proceedings, credentialing, or other legally authorized activities.

1. Workers’ compensation

We may disclose health information as authorized or required for workers’ compensation claims or similar programs that provide benefits for work-related injuries or illness.

1. Law enforcement and legal proceedings

We may disclose health information for certain law-enforcement purposes or in response to a court order, administrative order, subpoena, discovery request, or other lawful legal process, subject to the limitations and safeguards required by law.

1. Coroners, medical examiners, funeral directors, and organ donation

We may disclose health information to a coroner, medical examiner, funeral director, or organ-procurement organization when permitted or required by law.

1. Specialized government functions

We may disclose information for legally authorized military, national-security, protective-service, correctional, or other specialized government functions.

1. Research

We may use or disclose information for research only when the research has received any review, approval, waiver, authorization, or other protection required by law.

SUBSTANCE USE DISORDER RECORDS

To the extent Performance Edge PT creates, receives, or maintains substance-use-disorder patient records protected by 42 CFR Part 2, those records receive additional federal confidentiality protections.

Protected Part 2 records generally may not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you without your written consent or a court order and subpoena that meet applicable legal requirements.

Performance Edge PT is not a federally assisted substance-use-disorder treatment program. However, these protections may apply to certain records we receive from another provider or program.

USES AND DISCLOSURES REQUIRING WRITTEN AUTHORIZATION

We will obtain your written authorization before using or disclosing your protected health information when authorization is required by law.

Examples may include:

• Most uses or disclosures for marketing;
• Sale of protected health information;
• Public testimonials or identifiable promotional materials;
• Disclosure to a person or organization not otherwise permitted to receive the information; and
• Certain uses or disclosures of specially protected records.

You may revoke an authorization in writing at any time. Revocation will apply prospectively and will not affect uses or disclosures already made in reliance on the authorization.

OUR RESPONSIBILITIES

Performance Edge PT is required to:

• Maintain the privacy and security of your protected health information;
• Follow the duties and privacy practices described in the current Notice;
• Provide you with this Notice;
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information; and
• Use or disclose only the amount of information reasonably necessary when the minimum-necessary standard applies.

We will not use or disclose your health information for purposes not described in this Notice unless you provide written authorization or the use or disclosure is otherwise permitted or required by law.

CHANGES TO THIS NOTICE

We may change the terms of this Notice and make the revised Notice applicable to all health information maintained by Performance Edge PT, including information created or received before the revision.

The current Notice will be available upon request, displayed at our clinic, and posted on our website if we maintain a website describing our patient services. The Notice will identify its effective date.

NOTICE AVAILABILITY

You may obtain a paper or electronic copy of this Notice by contacting Performance Edge PT using the contact information at the beginning of this Notice.