Right to Request Additional Restrictions. You may request that we restrict or limit the uses and disclosures of your health information for treatment, payment and health care operations. You may also ask us to limit the health information we use or disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. While we consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction, except if the disclosure is to a health plan for purposes of carrying out payment or health operations (not treatment), and the health information relates solely to health care for which the health care provider involved has been paid out of pocket in full. To request restrictions, you must make your request in writing, signed and dated, to the address below. Your request must describe the information you want restricted, say whether you want to limit the use or the disclosure of the information, or both, and tell us who should not receive the restricted information. We will tell you whether we agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.