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- RowanSOM may permit an individual to request that it restrict:
- uses and disclosures of PHI about the individual to carry out treatment, payment or health care operations (TPO); and
- disclosure related to involvement in an individual's care.
- The Request for Restriction of Health Information Form Request for Restriction of Health Information Form [i] can be accessed on the Rowan.edu website.
- Rowan University School of Medicine units must send the Request for Restriction of Disclosure Form Request for Restriction of Disclosure Form [ii] to Ray Braeunig, Chief Compliance & Privacy Officer, for approval or denial. If denied, the rationale must be documented.
- All requests for restrictions and termination of the agreement to restrict must be in writing.
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By Direction of the President:
Signature on file
RowanSOM Chief Compliance and Privacy Officer
ATTACHMENTS 1
HYPERLINKS
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[i] Request for Restriction of Health Information Form:
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