Common use of Right to Request Restrictions on Use and Disclosure of PHI Clause in Contracts

Right to Request Restrictions on Use and Disclosure of PHI. You may request the Company to restrict its use and disclosure of your PHI to carry out treatment, payment or health care operations, or to restrict its use and disclosure to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care. However, the Company may not be required to agree to your request, unless you have paid out of pocket in full for services, depending on the specific facts. The Company will accommodate reasonable requests to receive communications of PHI by alternative means or alternative locations, such as a location other than your home. The Company will accommodate this request if you state in writing that you would be in danger from receiving communications through the normal means. You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your PHI. Such requests should be made to: Xxxxxx Xxxxxxxxxx, Senior Privacy Officer & Compliance Manager, Chubb Group, 000 Xxxx'x Xxxx Xxxx, Xxxxxxxxxx Xxxxxxx, XX 00000, phone: 0-000-000-0000.

Right to Request Restrictions on Use and Disclosure of PHI. You may request the Company to restrict its use and disclosure of your PHI to carry out treatment, payment or health care operations, or to restrict its use and disclosure to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care. However, the Company may not be required to agree to your request, unless you have paid out of pocket in full for services, depending on the specific facts. The Company will accommodate reasonable requests to receive communications of PHI by alternative means or alternative locations, such as a location other than your home. The Company will accommodate this request if you state in writing that you would be in danger from receiving communications through the normal means. You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your PHI. Such requests should be made to: Xxxxxx Xxxxxxxxxx, Senior Privacy Officer & Compliance Manager, Chubb Group, 000 Xxxx'x Xxxx’x Xxxx Xxxx, Xxxxxxxxxx Xxxxxxx, XX 00000, phone: 0-000-000-0000.

Right to Request Restrictions on Use and Disclosure of PHI. You may request the Company to restrict its use and disclosure of your PHI to carry out treatment, payment or health care operations, or to restrict its use and disclosure to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care. However, the Company may not be required to agree to your request, unless you have paid out of pocket in full for services, depending on the specific facts. The Company will accommodate reasonable requests to receive communications of PHI by alternative means or alternative locations, such as a location other than your home. The Company will accommodate this request if you state in writing that you would be in danger from receiving communications through the normal means. You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your PHI. Such requests should be made to: Xxxxxx XxxxxxxxxxXxxxx Xxxxxxxx, Senior Global Chief Privacy Officer & Compliance ManagerOfficer, Chubb Group, 000 Xxxx'x Xxxx Xxxx, Xxxxxxxxxx Xxxxxxx, XX 00000, phone: phone 0-000-00-XXXXX (0-000-000-0000).