Right to Request Restrictions
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations.
To request a restriction, you must put your request in writing. We are not required to agree to your request for restrictions, except in certain limited circumstances. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
To submit a request, either send us a letter as outlined in our Notice of Privacy Practices or download the form below: