Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health information. However, I am not required to agree to a restriction you request.
Appears in 5 contracts
Sources: Patient Services Agreement, General Information and Psychological Services Agreement, General Information and Psychological Services Agreement
Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health informationinformation about you. However, I am not required to agree to a restriction you request.
Appears in 3 contracts
Sources: Therapy Consent, Policies & Agreement, Informed Consent for Therapy Services, Treatment Agreement
Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health informationinformation regarding you. However, I am we are not required to agree to a restriction you request.
Appears in 3 contracts
Sources: Psychologist Client Services Agreement, Therapist Client Services Agreement, Therapist Client Services Agreement
Right to Request Restrictions. You have the right to request restrictions on certain that we restrict uses and or disclosures of protected your health informationinformation to carry out treatment, payment, health care operations, or communications with family or friends. However, I am We are not required to agree to a restriction you requestrestriction.
Appears in 3 contracts
Sources: Dental Plan Agreement, Dental Plan Agreement, Dental Plan Agreement
Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health informationinformation about you. However, I am we are not required to agree to a restriction you request. All restriction requests must be in writing and must state the dates of restriction, what information to restrict, and reason for restriction.
Appears in 1 contract
Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health informationinformation about you. However, I am we are not required to agree to a restriction you request.
Appears in 1 contract
Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health information. However, I am we are not required to agree to a restriction you request.
Appears in 1 contract