Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. To request a restriction in our use or disclosure of your PHI, you must make your request in writing to the Privacy Officer. Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our Practice’s use, disclosure, or both; and (c) to whom you want the limits to apply.
Appears in 7 contracts
Sources: Patient Agreement, Patient Agreement, Patient Agreement
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI IIHI for treatment, payment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. To In order to request a restriction in our use or disclosure of your PHIIIHI, you must make your request in writing to the Privacy Officer. Your request must describe in a clear and concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our Practicepractice’s use, disclosure, disclosure or both; and
(c) to whom you want the limits to apply.
Appears in 3 contracts
Sources: Patient Agreement, Direct Primary Care Patient Agreement, Patient Agreement
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI yourPHI for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. To In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to the Privacy Officer. Your request must describe in a clear and concise fashion:
(a) the The information you wish restricted;
(b) whether Whether you are requesting to limit our PracticeInterMed’s use, disclosure, disclosure or both; and
(c) to To whom you want the limits to applyapply We are required to agree to your request to restrict PHI from disclosure to a health plan provided that you have paid 100% for any of the services you request to be restricted.
Appears in 2 contracts
Sources: Patient Financial Policy Agreement, Patient Financial Policy Agreement
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, emergencies or when the information is necessary to treat you. To In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to the “Privacy Officer” designated above. Your request must describe in a clear and concise fashion:
(a) the : • The information you wish restricted;
(b) whether , • Whether you are requesting to limit our Practicepractice’s use, disclosure, disclosure or both; and
(c) to , • To whom you want the limits to apply.
Appears in 1 contract
Sources: Patient Agreement
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. To In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to the Privacy Officer. ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.
D. Your request must describe in a clear and concise fashion:
: (a) the information you wish restricted;
; (b) whether you are requesting to limit our Practicepractice’s use, disclosure, disclosure or both; and
and (c) to whom you want the limits to apply.
Appears in 1 contract
Sources: Confidentiality Agreement