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Restriction of Directory InformationPatient Name: Date of Birth: Street Address: Last 4 numbers of SSN: City, State, Zip: Telephone: () Patient Account #: Carolina's Healthcare System may include
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Restriction of directory informationdocx is needed by individuals or organizations that want to keep certain personal information private or restricted from public disclosure.
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Some common examples of who may need this document include:
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- Parents or guardians who want to restrict their child's personal information from being shared with outside parties.
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- Students who wish to limit the use of their personal information for promotional purposes.
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- Individuals who have concerns about privacy and want to exercise their rights to restrict the disclosure of certain information.
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- Schools or educational institutions that need to comply with privacy regulations and ensure the protection of students' personal data.
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The restriction of directory information refers to the process by which individuals can request that their personal information not be made publicly available in directory listings.
Typically, individuals such as students, parents, or guardians are required to file the restriction of directory information to protect their personal data.
To fill out the restriction of directory information document, you need to provide your personal details, indicate your request for restriction, and sign the form to certify your request.
The purpose is to ensure the privacy of individuals by preventing their personal information from being disclosed in public directories.
The information that must be reported includes the individual's name, contact details, the specific directory information being restricted, and any other relevant personal identifiers.
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