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:
If you do not want Salem Health to disclose your patient information for a specific visit to your health plan, you must make a written request in advance of the visit, pay for the services in full prior to the date the services are provided, and notify the registrar at the time services are provided.