Common use of Right to Request Restrictions Clause in Contracts

Right to Request Restrictions. You have the right to request a restriction or limitation on the health and financial information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health and financial information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received. We are not required to agree to your request. If we do agree, that agreement must be in writing and signed by you and us.

Right to Request Restrictions. You have the right to request a restriction or limitation on the health and financial information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health hea lth and financial information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment treatm ent that you received. We are not required to agree to your request. If we do agree, that agreement must be in writing and signed by you and us.

Right to Request Restrictions. You have the right to request a restriction or limitation on the health and financial medical information we use or disclose about you for treatment, payment, payment or health care operations. You also have the right to request a limit on the health and financial medical information we disclose about you to someone, such as a family member or friend, someone who is involved in your care or in the payment of for your care, like a family member or friend. For exampleIn your request, you could ask that we not use must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or disclose information regarding a particular treatment that both; and (3) to whom you received. We are not required want the limits to agree to your request. If we do agree, that agreement must be in writing and signed by you and usapply.