Common use of Right to Request Restrictions Clause in Contracts

Right to Request Restrictions. You have the right to request restrictions on the ways in which we use and disclose your health information for treatment, payment and health care operations, or disclose this information to disaster relief organizations or individuals who are involved in your care. We do not have to agree to the restrictions you request. You may request a restriction on the use or disclosure of your health information by writing to: Fidelis Care, Member Services, 00-00 Xxxxxx Xxxxxxxxx, Xxxx Xxxx, New York 11374.