Right to Request Restrictions. You have the right to request that we follow additional, special restrictions when disclosing your information. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment as determined by a doctor. To request restrictions, you must make your request in writing to your service provider. In your request, you must tell us what information you want to limit, the type of limitation, and to whom you want the limitation to apply.
Appears in 3 contracts
Samples: Agency Participation Agreement, Agency Participation Agreement, Agency Participation Agreement
Right to Request Restrictions. You have the right to request that a limitation or restriction on the health information we follow additionaluse or disclose regarding your treatment, special restrictions when disclosing payment or health care operations. You also have the right to request a limit on the health information we disclose with family members, or caregivers, who are involved with your information. We are care; however, Easy Speech Pathology is not required to agree to your request. If request if we do agree, we will comply with your request unless feel that the information is needed to provide you with emergency treatment as determined by a doctortreatment. To request restrictions, you You must make your request for any restrictions in writing to your service providerEasy Speech Pathology. In your request, you must tell us what information you want to limit, the type of limitation, limit and to whom you want the limitation limits to applyapply to.
Appears in 1 contract
Samples: Disclosure and Agreement
Right to Request Restrictions. You have the right to request that a restriction or limitation on the medical information we follow additionaluse or disclose about you for treatment, special restrictions when disclosing your informationpayment or health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment as determined by a doctortreatment. To request restrictions, you must make your request in writing to your service providerMedical Records marked "personal and confidential". In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, the type of limitation, disclosure or both; and (3) to whom you want the limitation limits to apply.
Appears in 1 contract