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SHOT Health is dedicated to maintaining the privacy of your protected health information (‘PHI’). PHI is information about you that may be used to identify you (such as your name, social security number or address), and that relates to (a) your past, present or future physical or mental health or condition, (b) the provision of healthcare to you, or (c) your past, present, or future payment for the provision of healthcare. In conducting its business, SHOT Health will receive and create records containing your PHI. SHOT Health is required by law to maintain the privacy of your PHI and to provide you with notice of its legal duties and privacy practices with respect to your PHI.
SHOT Health must abide by the terms of this Notice while it is in effect. This current Notice takes effect on October 1, 2020 and will remain in effect until SHOT Health replaces it. SHOT Health reserves the right to change the terms of this Notice at any time, as long as the changes are in compliance with applicable law. If SHOT Health changes the terms of this Notice, the new terms will apply to all PHI that it maintains, including PHI that was created or received before such changes were made. If SHOT Health changes this Notice, it will post the new Notice on its Website and will make the new Notice available upon request.
SHOT Health may use and disclose your PHI in the following ways:
1.Treatment and Healthcare Operations. SHOT Health is permitted to use and disclose your PHI for purposes of (a) treatment and (b) healthcare operations.
For example:
Authorization. Except as otherwise provided in this notice or otherwise permitted under the HIPAA Privacy Rule, uses and disclosures of Protected Health Information will be made only with your written authorization subject to your right to revoke such authorization SHOT Health is permitted to use and disclose your PHI upon your written authorization, to the extent such use or disclosure is consistent with your authorization. You may revoke any such authorization at any time, in writing, by sending a revocation notice to the privacy officer at the address mentioned
3.As Required by Law. SHOT Health may use and disclose your PHI to the extent required by law.
The following categories describe unique circumstances in which SHOT Health may use or disclose your PHI:
A.Public Health Activities. SHOT Health may disclose your PHI to public health authorities or other governmental authorities for purposes including preventing and controlling disease, reporting child abuse or neglect, reporting domestic violence and reporting to the Food and Drug Administration regarding the quality, safety, and effectiveness of a regulated product or activity. In certain circumstances, SHOT Health may disclose the PHI of a person who has been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
B.Workers’ Compensation. SHOT Health may disclose your PHI as authorized by, and to the extent necessary to comply with, workers’ compensation programs and other similar programs relating to work-related illnesses or injuries.
C.Health Oversight Activities. SHOT Health may disclose your PHI to a health oversight agency for authorized activities such as audits, investigations, inspections, licensing, and disciplinary actions relating to the healthcare system or government benefit programs.
D.Judicial and Administrative Proceedings. SHOT Health may disclose your PHI, in certain circumstances, as permitted by applicable law, in response to an order from a court or administrative agency, or in response to a subpoena or discovery request.
E.Law Enforcement. SHOT Health may, under certain circumstances, disclose your PHI to a law enforcement official, such as for purposes of identifying or locating a suspect, fugitive, material witness, or missing person.
F.Decedents. Under certain circumstances, SHOT Health may disclose PHI to coroners, medical examiners, and funeral directors for purposes such as identification, determining the cause of death, and fulfilling duties relating to decedents.
G.Organ Procurement. Under certain circumstances, SHOT Health may use or disclose PHI for organ donation and transplantation purposes.
H.Research. SHOT Health may, under certain circumstances, use or disclose PHI that is necessary for research purposes.
I.Threat to Health or Safety. Under certain circumstances, SHOT Health may use or disclose PHI if necessary, to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
J.Specialized Government Functions. SHOT Health, may in certain situations, use and disclose PHI of persons who are, or were, in the Armed Forces for purposes such as ensuring proper execution of a military mission or determining entitlement to benefits. SHOT Health may also disclose PHI to federal officials for intelligence and national security purposes.
You have the following rights regarding the PHI maintained by SHOT Health:
K.Confidential Communication. You have the right to receive confidential communications of your PHI. You may request that SHOT Health communicates with you through alternate means or at an alternate location, and SHOT Health will accommodate your reasonable requests. You must submit your request in writing to SHOT Health.
L.Restrictions. You have the right to request restrictions on certain uses and disclosures of PHI for treatment, payment, or healthcare operations. You also have the right to request that SHOT Health restrict its disclosures of PHI to only certain individuals involved in your care or the payment of your care. You must submit your request in writing to SHOT Health. SHOT Health is not required to comply with your request. However, if SHOT Health agrees to comply with your request, it will be bound by such agreement, except when otherwise required by law or in the event of an emergency.
M.Inspection and Copies. You have the right to inspect and copy your PHI. You must submit your request in writing to SHOT Health. SHOT Health may impose a fee for the costs of copying, mailing, labor, and supplies associated with your request. SHOT Health may deny your request to inspect and/or copy your PHI in certain limited circumstances. If that occurs, SHOT Health will inform you of the reason for the denial, and you may request a review of the denial.
N.Amendment. You have a right to request that SHOT Health amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is maintained by SHOT Health. You must submit your request in writing to SHOT Health and provide a reason to support the requested amendment. SHOT Health may, under certain circumstances, deny your request by sending you a written notice of denial. If SHOT Health denies your request, you will be permitted to submit a statement of disagreement for inclusion in your records.
O.Accounting of Disclosures. You have a right to receive an accounting of all disclosures SHOT Health has made of your PHI. However, that right does not include disclosures made for treatment, payment, or healthcare operations, disclosures made to you about your treatment, disclosures made pursuant to an authorization, and certain other disclosures. You must submit your request in writing to SHOT Health, and you must specify the time period involved (which must be for a period of time less than six years from the date of the disclosure). Your first accounting will be free of charge. However, SHOT Health may charge you for the costs involved in fulfilling any additional request made within a period of 12 months. SHOT Health will inform you of such costs in advance so that you may withdraw or modify your request to save costs.P. Decedents. Under certain circumstances, SHOT Health may disclose PHI to coroners, medical examiners, and funeral directors for purposes such as identification, determining the cause of death, and fulfilling duties relating to decedents.
P.Breach Notification. You have the right to be notified in the event that SHOT Health (or a SHOT Health Business Associate) discovers a breach of unsecured PHI.
Q.Paper Copy. You have the right to obtain a paper copy of this Notice from SHOT Health at any time upon request. To obtain a paper copy of this notice, please contact the Privacy Officer by writing to: Privacy Officer, SHOT Health, 5908 Breckenridge Pkwy, Tampa, FL 33610 or sending an email to info@SHOThealth.com.
R.Complaint. You may complain to SHOT Health and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint with SHOT Health, you must submit a statement in writing to: Privacy Officer, SHOT Health 5908 Breckenridge Pkwy, Tampa, FL, or sending an email to info@SHOThealth.com. SHOT Health will not retaliate against you for filing a complaint.
S.Further Information. If you would like more information about your privacy rights, please send an email to the Privacy Officer at info@SHOThealth.com.
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