(a) A general acute care hospital shall inform a patient or the patient’s representative, at the time of admission or as soon as reasonably possible in cases of patient incapacity or an emergency treatment circumstance, that the patient may restrict or prohibit the use or disclosure of protected health information in the hospital’s patient directory, as provided in Section 164.510 of Title 45 of the Code of Federal Regulations, in both of the following manners:

1. (1) Using a separate paper or digital document that only includes an acknowledgment of receipt of the hospital’s notice of privacy practices required by Section 164.520 of Title 45 of the Code of Federal Regulations and information regarding the hospital’s directory and the included protected health information. The separate document shall include a check box for the patient or the patient’s representative to mark to restrict or prohibit use or disclosure of the protected health information in the hospital’s patient directory.
2. (2) Having hospital personnel verbally inform the patient or the patient’s representative of the patient’s right to restrict or prohibit the use or disclosure of protected health information.