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Your request must state the specific restriction requested and to
whom you want the restriction to apply. We are not required to
agree to a restriction that you may request, but if we do agree to
the requested restriction, we may not use or disclose your Medi-
cal Information in violation of that restriction unless it is needed
to provide emergency treatment. If you would like to request a
restriction of the use of your Medical Information, please down-
load our Request Form at
http://www.myomniPod.com/images/upload/
HIPAA_Privacy_Notice_Request_Form.pdf
and follow the directions included on that form.
We will respond to your request in a reasonable amount of time.
Please contact our Privacy Officer if you have questions about
requesting a restriction of the use of your Medical Information.
You Have the Right to Request to Receive Confidential
Communications from Us by Alternative Means or at an
Alternative Location: We will accommodate reasonable requests
to receive confidential communications from us by alternate
means or at an alternative location. We may also limit this
accommodation by asking you for information as to how
payment will be handled or specification of an alternative
address or other method of contact. We will not request an
explanation from you as to the basis for the request. Please make
this request in writing to our Privacy Officer.
You Have the Right to Receive an Accounting of Certain
Disclosures We Have Made, if any, of Your Medical Information:
This right applies to disclosures for purposes other than
treatment, payment, or healthcare operations as described in
this HIPAA Privacy Notice. It excludes disclosures we may have
made to you, for a facility directory, to family members or friends
involved in your care, or for notification purposes. You have the
right to receive specific information regarding these disclosures
that occurred after April 14, 2003, or as otherwise provided for
under applicable law. You may request a shorter time frame. The
right to receive this information is subject to certain exceptions,
restrictions, and limitations. If you would like to request an
accounting of certain disclosure of your Medical Information,
please download our Request Form at
http://www.myomniPod.com/images/upload/
HIPAA_Privacy_Notice_Request_Form.pdf
and follow the directions included on that form.
We will respond to your request in a reasonable amount of time.
Please contact our Privacy Officer if you have questions about
requesting an accounting of the disclosures of your Medical
Information.
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