CO-MPP-L_FormTemplateD.doc - (DENIAL LETTER TEMPLATE OF...

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(DENIAL LETTER TEMPLATE OF REQUEST FOR RESTRICTION) Patient Name Address City, State Zip Code (Patient Name) : The County of San Diego provides each individual (patient/client/resident) the right to request restrictions on uses of his or her protected health information. Each request is carefully reviewed subject to the limitations outlined by federal regulations (45 CFR Parts 160 and 164). Your request to restrict certain uses or disclosures of your protected health information has been denied for the following reason(s): Based on our system and process requirements, we are unable to comply with the restriction you requested. The request was not made in writing.
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