Request for PHI Restrictions
Op10.03-11 Request for PHI Restrictions
Complies with the Administrative Requirements of the Health Insurance Portability and Accountability Act of 1996. 45 CFR Section 164.522(a)
Participants have the right to request restrictions on how their Protected Health Information ("PHI") is used and/or disclosed for treatment, payment and health care operations.
- Participants are informed of their right to request restrictions on the use and disclosure of their PHI in the Employee Benefit Plan's Notice of Privacy Practices ("Notice").
- All requests by participants for restrictions on the use and disclosure of their PHI must be in writing and forwarded to the Human Resources Assistant Director or designee for approval.
- Workforce members or Business Associates who perform plan functions may not grant or deny a participant's request for restrictions without prior authorization from the Human Resources Assistant Director or designee.
When a request for restriction(s) is accepted by the Employee Benefit Plan:
- The participant will be informed of any potential consequences of the restriction;
- A notation will be made in the participant's record(s);
- The Employee Benefit Plan will not use or disclose PHI inconsistent with the agreed restriction, nor will its Business Associates;
- The participant will be informed that the Employee Benefit Plan is not required to comply with the agreed upon restriction(s) in emergency treatment situations when the restricted PHI is needed for treatment;
- If the agreed upon restriction hampers treatment, the Employee Benefit Plan will ask the participant to modify or revoke the restriction and get written agreement to the modification or revocation or document an oral agreement;
- The use and/or disclosure of PHI will be consistent with the status of the restriction in effect on the date it is used or disclosed; and
- Written documentation of the agreed to restriction will be maintained for six (6) years from the date of its creation or the date when it was last in effect, whichever is later.
When a request for restriction(s) is denied by the Employee Benefit Plan:
- The participant will be given the opportunity to discuss his or her privacy concerns, if desired; and
- Efforts will be made to assist the participant in modifying the request for restrictions to accommodate his or her concerns and obtain acceptance by the Employee Benefit Plan.
Effective Date: April 14, 2003