Request For Restriction
By completing this form below, I understand that Mosaic Life Care does not have to agree to a restriction. I understand that if Mosaic Life Care agrees to a restriction, Mosaic Life Care may still use and disclose my information for:
- Emergency treatment
- When I request to access my information
- When I request an accounting of disclosures
- For facility directories
- For uses/disclosures for which consent, authorization or an opportunity to agree or object is not required.