Health Information Exchange (Hie) Patient Opt-Out Form

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UC San Diego Health System
Health Information Exchange Patient Opt-Out Information
This form is to be used by patients who do not wish to participate in UC San Diego Health System’s
(UCSDHS) national and regional Health Information Exchange (HIE), or if a patient wishes to rescind
a previous decision to opt out. Please read the following information carefully before submitting your
opt-out form.
What is a Health Information Exchange or HIE?
A Health Information Exchange, or HIE, is a way of sharing your health information among participating doctors’
offices, hospitals, labs, radiology centers, and other health care providers through secure, electronic means. The
purpose is so that each of your participating caregivers can have the benefit of the most recent information available
from your other participating caregivers when taking care of you.
What is in my UCSDHS HIE patient record?
Your UCSDHS HIE patient record will include your medications, allergies, current and past test results, and
summaries of your past and current health problems. It will not include psychotherapy and sensitive notes or other
information that requires your specific authorization to release under federal law. Having timely access to a more
complete and accurate health record will help your caregivers work together more easily, make better decisions about
your care, eliminate redundant forms, and reduce mistakes, especially in an emergency.
Who can see my records?
Only health care providers who are treating you and their associated staff who are specifically given rights to the HIE
network can access your records through UCSDHS HIE. For example, if one of your providers participates in UCSDHS
HIE, he or she can access your health information maintained by your other providers who also participate in UCSDHS HIE.
How is my health information protected?
UCSDHS is committed to keeping your records private and secure. Clear and strict federal and state guidelines
govern how your health information can be exchanged, viewed, or used. Information that identifies you will not be
sold or made available for other purposes. Only those that care for you will be able to view your health information,
and only when needed to provide or coordinate your care, make referrals, submit mandatory public health reports
(such as your vaccination history), or to provide health care benefits to you.
What can UCSDHS HIE do for me?
If you see multiple doctors who participate in UCSDHS HIE, they may see a more complete picture of your health, and
make more informed treatment decisions. The goal is for you to receive coordinated care more efficiently. Your health
care information is available to participating health care providers where and when they need it without delay.
Are there risks to opting out?
Yes. The goal of UCSDHS HIE is to provide your caregivers outside UCSDHS secure access to the best available
information about your health. By opting out of health information exchange, your caregivers outside UCSDHS may
have less information about you when making a diagnosis for you, or when making decisions with you about your care.
I don’t want to participate. How can I opt out?
Your health information will be visible to your caregivers through UCSDHS HIE unless you opt-out using this form or
by contacting UCSDHS Health Information Services at (619) 543-5707. You may also opt-out via your MyUCSDChart at
Please allow up to two business days for processing your opt out request.
Your choice to opt-out of the Health Information Exchange will not affect your ability to access medical care. Opting
out will not prevent your caregivers from sharing your health information with authorized entities when necessary for
public health or research purposes that are permitted or required by UCSDHS as well
as federal and state law. In cases of medical emergency, your doctor may request to
view your health record to diagnose or treat your emergency medical condition and
UCSDHS HIE will make your records available under such circumstances.
D3630 (4-15) Page 1 of 2

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