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 your protected health information that we use or disclose for treatment, payment; or healthcare operations. You also have the right to request a limit on your protected health information that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had. We are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it, or we notify you. To request restrictions, you must make your request in writing and sent by facsimile to Soberlink Healthcare LLC @ 000-000-0000 Attn: Privacy Officer, by mail to Soberlink Healthcare LLC, Attn: Privacy Officer, 00000 Xxxxx Xxxxxxxxx, #000, Xxxxxxxxxx Xxxxx, XX 00000 or by email to xxxxxxx@xxxxxxxxx.xxx. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply — for example, disclosures to your spouse.