Common use of Friends and Personal Representatives Clause in Contracts

Friends and Personal Representatives. With Your written authorization, We may disclose to family members, close personal friends, or another person You identify, Your protected health information relevant to their involvement with Your care or paying for Your care. If You are unavailable, incapacitated or involved in an emergency, and We determine that a limited disclosure is in Your best interests, We may disclose Your protected health information to such persons without Your approval. We may also disclose Your protected health information to public or private entities to assist in disaster relief efforts. We are permitted or required by law to use or disclose Your protected health information, without Your authorization, in the following circumstances: For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We believe an individual is a victim of abuse, neglect or domestic violence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery request); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You are a member of the armed forces, for intelligence or national security issues; or about an inmate or an individual to a correctional institution or law enforcement official having custody; and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We may make other uses and disclosures of protected health information only with Your written authorization. You have the right to request communications regarding Your protected health information from Us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a confidential communication can be obtained from the Privacy Officer. You have the right to inspect and/or obtain a copy of Your protected health information We maintain in Your designated record set, with a few exceptions. To request access, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request access to Your protected health information can be obtained from the Privacy Officer. A fee will be charged to You for copying and postage.

Friends and Personal Representatives. With Your written authorization, We may disclose to family members, close personal friends, or another person You identify, Your protected health information relevant to their involvement with Your care or paying for Your care. If You are unavailable, incapacitated or involved in an emergency, and We determine that a limited disclosure is in Your best interests, We may disclose Your protected health information to such persons without Your approval. We may also disclose Your protected health information to public or private entities to assist in disaster relief efforts. Other Uses and Disclosures. We are permitted or required by law to use or disclose Your protected health information, without Your authorization, in the following circumstances: • For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We believe an individual is a victim of abuse, neglect or domestic violence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery request); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You are a member of the armed forces, for intelligence or national security issues; or about an inmate aninmate or an individual to a correctional institution or law enforcement official having custody; and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We may make other uses and disclosures of protected health information only with Your written authorization. Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You have the right to request certain restrictions on how We use or disclose Your protected health information for treatment, payment or health care operations. You also have the right to request restrictions on disclosures to family members or others who are involved in Your care of the paying of Your health care. To request a restriction, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to Your request for a restriction, except for a restriction to disclose Your protected health information to a health plan if the purpose is to carry out payment or health care operations which is not otherwise required by law and the protected health information pertains solely to a health care item or service for which a person, other than the health plan, has paid the health care provider in full. If We agree to Your request for a restriction, You will receive a written acknowledgement from us. Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your protected health information from Us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a confidential communication can be obtained from the Privacy Officer. Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your protected health information We maintain in Your designated record set, with a few exceptions. To request access, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request access to Your protected health information can be obtained from the Privacy Officer. A fee will be charged to You for copying and postage.

Friends and Personal Representatives. With Your your written authorization, We we may disclose to family members, close personal friends, or another person You you identify, Your your protected health information relevant to their involvement with Your your care or paying for Your your care. If You you are unavailable, incapacitated or involved in an emergency, and We we determine that a limited disclosure is in Your your best interests, We we may disclose Your your protected health information to such persons without Your your approval. We may also disclose Your your protected health information to public or private entities to assist in disaster relief efforts. Other Uses and Disclosures. We are permitted or required by law to use or disclose Your your protected health information, without Your your authorization, in the following circumstances: • For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We we believe an individual is a victim of abuse, neglect or domestic violencedomesticviolence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery request); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You you are a member of the armed forces, for intelligence or national security issues; or about an inmate or an individual to a correctional institution or law enforcement official having custody; and custody;and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We we may make other uses and disclosures of protected health information only with Your your written authorization. Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You have the right to request certain restrictions on how we use or disclose your protected health information for treatment, payment or health care operations. You also have the right to request restrictions on disclosures to family members or others who are involved in your care of the paying of your health care. To request a restriction, you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to your request for a restriction, except for a restriction to disclose your protected health information to a health plan if the purpose is to carry out payment or health care operations which is not otherwise required by law and the protected health information pertains solely to a health care item or service for which a person, other than the health plan, has paid the health care provider in full. If we agree to your request for a restriction, you will receive a written acknowledgement from us. Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your your protected health information from Us us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a confidential communication can be obtained from the Privacy Officer. Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your your protected health information We we maintain in Your your designated record set, with a few exceptions. To request access, You you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request access to Your your protected health information can be obtained from the Privacy Officer. A fee will be charged to You you for copying and postage.

Friends and Personal Representatives. With Your your written authorization, We we may disclose to family members, close personal friends, or another person You you identify, Your your protected health information relevant to their involvement with Your your care or paying for Your your care. If You you are unavailable, incapacitated or involved in an emergency, and We we determine that a limited disclosure is in Your your best interests, We we may disclose Your your protected health information to such persons without Your your approval. We may also disclose Your your protected health information to public or private entities to assist in disaster relief efforts. Other Uses and Disclosures. We are permitted or required by law to use or disclose Your your protected health information, without Your your authorization, in the following circumstances: • For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We we believe an individual is a victim of abuse, neglect or domestic violence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery request); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You you are a member of the armed forces, for intelligence or national security issues; or about an inmate or an individual to a correctional institution or law enforcement official having custody; and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We we may make other uses and disclosures of protected health information only with Your your written authorization. Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You have the right to request certain restrictions on how we use or disclose your protected health information for treatment, payment or health care operations. You also have the right to request restrictions on disclosures to family members or others who are involved in your care of the paying of your health care. To request a restriction, you must send a written request to: Privacy Officer, Health One Alliance, LLC, P .O. Xxx 0000, Xxxxxx, XX 00000. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to your request for a restriction, except for a restriction to disclose your protected health information to a health plan if the purpose is to carry out payment or health care operations which is not otherwise required by law and the protected health information pertains solely to a health care item or service for which a person, other than the health plan, has paid the health care provider in full. If we agree to your request for a restriction, you will receive a written acknowledgement from us. Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your your protected health information from Us us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128X.X. Xxx 0000, DaltonXxxxxx, GA 30722XX 00000. A form to request a confidential communication can be obtained from the Privacy Officer. Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your your protected health information We we maintain in Your your designated record set, with a few exceptions. To request access, You you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128X.X. Xxx 0000, DaltonXxxxxx, GA 30722XX 00000. A form to request access to Your your protected health information can be obtained from the Privacy Officer. A fee will be charged to You you for copying and postage.

Friends and Personal Representatives. With Your your written authorization, We we may disclose to family members, close personal friends, or another person You you identify, Your your protected health information relevant to their involvement with Your your care or paying for Your your care. If You you are unavailable, incapacitated or involved in an emergencyemergency situation, and We we determine that a limited disclosure is in Your your best interests, We we may disclose Your your protected health information to such persons without Your your approval. We may also disclose Your your protected health information to public or private entities to assist in disaster relief efforts. Other Uses and Disclosures. We are permitted or required by law to use or disclose Your your protected health information, without Your your authorization, in the following circumstances: • For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We we believe an individual is a victim of abuse, neglect or domestic violence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery request); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You you are a member of the armed forces, for intelligence or national security issues; or about an inmate or an individual to a correctional institution or law enforcement official having custody; and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We we may make other uses and disclosures of protected health information only with Your your written authorization. Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You have the right to request certain restrictions on how we use or disclose your protected health information for treatment, payment or health care operations. You also have the right to request restrictions on disclosures to family members or others who are involved in your care of the paying of your health care. To request a restriction, you must send a written request to: Privacy Officer, Alliant Health Plans, 0000 X. Xxxxx Rd, Dalton, GA 30720. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to your request for a restriction, except for a restriction to disclose your protected health information to a health plan if the purpose is to carry out payment or health care operations which is not otherwise required by law and the protected health information pertains solely to a health care item or service for which a person, other than the health plan, has paid the health care provider in full. If we agree to your request for a restriction, you will receive a written acknowledgement from us. Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your your protected health information from Us us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You you must send a written request to: Privacy Officer, Alliant Health One AlliancePlans, LLC, P.O. Box 11280000 X. Xxxxx Rd, Dalton, GA 3072230720. A form to request a confidential communication can be obtained from the Privacy Officer. Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your your protected health information We we maintain in Your your designated record set, with a few exceptions. To request access, You you must send a written request to: Privacy Officer, Alliant Health One AlliancePlans, LLC, P.O. Box 11280000 X. Xxxxx Rd, Dalton, GA 3072230720. A form to request access to Your your protected health information can be obtained from the Privacy Officer. A fee will be charged to You you for copying and postage.

Friends and Personal Representatives. With Your your written authorization, We we may disclose to family members, close personal friends, or another person You you identify, Your your protected health information relevant to their involvement with Your your care or paying for Your your care. If You you are unavailable, incapacitated or involved in an emergency, and We we determine that a limited disclosure is in Your your best interests, We we may disclose Your your protected health information to such persons without Your your approval. We may also disclose Your your protected health information to public or private entities to assist in disaster relief efforts. Other Uses and Disclosures. We are permitted or required by law to use or disclose Your your protected health information, without Your your authorization, in the following circumstances: • For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We we believe an individual is a victim of abuse, neglect or domestic violence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery requestdiscoveryrequest); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You you are a member of the armed forces, for intelligence or national security issues; or about an inmate or an individual to a correctional institution or law enforcement official having custody; and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We we may make other uses and disclosures of protected health information only with Your your written authorization. Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You have the right to request certain restrictions on how we use or disclose your protected health information for treatment, payment or health care operations. You also have the right to request restrictions on disclosures to family members or others who are involved in your care of the paying of your health care. To request a restriction, you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to your request for a restriction, except for a restriction to disclose your protected health information to a health plan if the purpose is to carry out payment or health care operations which is not otherwise required by law and the protected health information pertains solely to a health care item or service for which a person, other than the health plan, has paid the health care provider in full. If we agree to your request for a restriction, you will receive a written acknowledgement from us. Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your your protected health information from Us us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a confidential communication can be obtained from the Privacy Officer. Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your your protected health information We we maintain in Your your designated record set, with a few exceptions. To request access, You you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request access to Your your protected health information can be obtained from the Privacy Officer. A fee will be charged to You you for copying and postage.

Friends and Personal Representatives. With Your written authorization, We may disclose to family members, close personal friends, or another person You identify, Your protected health information relevant to their involvement with Your care or paying for Your care. If You are unavailable, incapacitated or involved in an emergency, and We determine that a limited disclosure is in Your best interests, We may disclose Your protected health information to such persons without Your approval. We may also disclose Your protected health information to public or private entities to assist in disaster relief efforts. Other Uses and Disclosures. We are permitted or required by law to use or disclose Your protected health information, ,without Your authorization, in the following circumstances: • For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We believe an individual is a victim of abuse, neglect or domestic violence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or proceedingsor actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery request); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing ormissing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You are a member of the armed forces, for intelligence or national security issues; or about an inmate aninmate or an individual to a correctional institution or law enforcement official having custody; and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or useor disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your mental condition or any substance anysubstance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We may make other uses and disclosures of protected health information only with Your written authorization. Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You havethe right to request certain restrictions on how We use or disclose Your protected health information for treatment, payment orhealth care operations. You also have the right to request restrictions on disclosures to family members or others who are involved in Your care of the paying of Your health care. To request a restriction, You must send a written request to: Privacy Officer, Health One Alliance, LLC, X.X. Xxx 0000, Xxxxxx, XX 00000. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to Your request for a restriction, except for a restriction to disclose Your protectedhealth information to a health plan if the purpose is to carry out payment or health care operations which is not otherwise required by law and the protected health information pertains solely to a health care item or service for which a person, other than the health plan, has paid the health care provider in full. If We agree to Your request for a restriction, You will receive a written acknowledgement from Us. Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your protected health information from Us by alternative means (for example by fax) or at alternative locationsalternativelocations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128X.X. Xxx 0000, DaltonXxxxxx, GA 30722XX 00000. A form to request a confidential communication can be obtained from the Privacy Officer. Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your protected health information We maintain in Your designated record set, with a few exceptions. To request access, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128X.X. Xxx 0000, DaltonXxxxxx, GA 30722XX 00000. A form to request access to Your protected health information can be obtained from the Privacy Officer. A fee will be charged to You for copying and postage.

Friends and Personal Representatives. With Your written authorization, We may disclose to family members, close personal friends, or another person You identify, Your protected health information relevant to their involvement with Your care or paying for Your care. If You are unavailable, incapacitated or involved in an emergency, and We determine that a limited disclosure is in Your best interestsinterest, We may disclose Your protected health information to such persons without Your approval. We may also disclose Your protected health information to public or private entities to assist in disaster relief efforts. Other Uses and Disclosures. We are permitted or required by law to use or disclose Your protected health information, without Your authorization, in the following circumstances: • For any purpose required by law; • For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect); • To a governmental authority if We believe an individual is a victim of abuse, neglect or domestic violence; • For health oversight activities (for example, inspections, licensure actions or civil, administrative or criminal proceedings or actions); • For judicial or administrative proceedings (for example, pursuant to a court order, subpoena or discovery request); • For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses or missing people); • To coroners and funeral directors; • For procurement, banking or transplantation of organ, eye or tissue donations; • For certain research purposes; • To avert a serious threat to health or safety under certain circumstances; • For military activities if You are a member of the armed forces, for intelligence or national security issues; or about an inmate aninmate or an individual to a correctional institution or law enforcement official having custody; and • For compliance with workers’ compensation insurance purposes. We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We may make other uses and disclosures of protected health information only with Your written authorization. Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You have the right to request certain restrictions on how We use or disclose Your protected health information for treatment, payment or health care operations. You also have the right to request restrictions on disclosures to family members or others who are involved in Your care of the paying of Your health care. To request a restriction, You must send a written request to: Privacy Officer, Health One Alliance, LLC, X.X. Xxx 0000, Xxxxxx, XX 00000. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to Your request for a restriction, except for a restriction to disclose Your protected health information to a health plan if the purpose is to carry out payment or health care operations which is not otherwise required by law and the protected health information pertains solely to a health care item or service for which a person, other than the health plan, has paid the health care provider in full. If We agree to Your request for a restriction, You will receive a written acknowledgement from Us. Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your protected health information from Us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128X.X. Xxx 0000, DaltonXxxxxx, GA 30722XX 00000. A form to request a confidential communication can be obtained from the Privacy Officer. Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your protected health information We maintain in Your designated record set, with a few exceptions. To request access, You you must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128X.X. Xxx 0000, DaltonXxxxxx, GA 30722XX 00000. A form to request access to Your protected health information can be obtained from the Privacy Officer. A fee will be charged to You for copying and postage.