Right to Request Restriction of Health Information

In order to provide safe, high quality care when you are treated at Atrium Health, your health information may be used or shared by Atrium Health employees who are caring for you. Your health information may also be shared with your insurance company for payment or with other Atrium Health employees for business purposes, such as audits and quality reviews. Atrium Health employees have been trained to respect the privacy and confidentiality of your health information. You have the right to ask that your health information not be shared with or used by certain people, groups, or companies. This is known as a request for restriction.

We want to help you understand your right to request a restriction on the use or sharing of your health information, as well as what to expect from Atrium Health.

What to Expect:

• You can ask for a restriction by completing a Request for Restriction form and sending it to Corporate HIM, Atrium Health, PO Box 32861, Charlotte, NC 28232-2861: English | en Español
• Except in certain circumstances,* we do not have to agree to your request not to use or share your health information, particularly if it would affect the quality or safety of your care. 
• We will send you a letter to let you know whether we accept or deny your request. Your request does not go in to effect until you receive our letter.
• If we agree to your request, it will be effective with your current visit and for future treatment, payment or business purposes.
• If you need emergency care for which the restricted information is necessary, the restrictions will not apply. We will ask the healthcare providers involved in your emergency treatment not to further use or share your restricted information.
• You may ask us to end the restriction at any time by either telling us or writing us. 
• We may also end a restriction to which we have agreed, but if we do so, we will tell you in writing. It will only affect your health information created or received after we have told you we are ending the restriction.

*If you ask us not to bill your insurance company for a visit or test for privacy purposes and you pay for that visit or test in full at that time (or as outlined by our payment policy), we must agree to your request. When you ask for this type of restriction, a different form is used and is usually completed at the time you are registering for treatment. The form explains how this type of restriction works, so please read it carefully. The registration staff will help you with this type of request for restriction.