At Tampa General Hospital, your privacy matters to us. We are committed to protecting your health information.
Your Right to Request Restrictions
You have the right to ask us to limit how your health information is used or shared.
You can request limits on how your information is used for:
- Treatment
- Payment
- Healthcare operations
You can also change your mind at any time and ask us to remove a restriction you previously requested.
How Requests Work
Submitting a Request
- All requests must be in writing.
- You will receive a written response letting you know if your request is approved or denied.
How to Request or Remove a Restriction
Request a Restriction:
Complete a Request for Restriction(s) Form and submit it using the instructions on the form.
Remove (Revoke) a Restriction:
To remove a restriction that was previously approved:
Complete a Revocation of Restriction(s) Form and submit it using the instructions on the form.
What to Expect
We Will Review Your Request Will Be Reviewed
- Every request is carefully reviewed.
- In most cases, we are not required to agree, but we will always consider your request.
If Your Request Is Approved
- We will follow the restriction you requested.
- The restriction will be added to your medical record.
Important: Even if a restriction is in place, we may still share your information if:
- It is needed for emergency treatment, or
- Sharing is required by law
Special Situation: Paying Out-of-Pocket
If you pay in full for a service yourself and ask us not to share that information with your health insurance:
- We are required to honor your request, unless the law requires us to share the information.
If you have questions, please contact the Health Information Management Department, Release of Information section at (813) 844-7533.