Nc Health Information Exchange Patient Opt-Out Form

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NC Health Information Exchange Patient Opt-Out Info
This form is to be used by patients who do not wish to participate in
North Carolina’s statewide health information exchange, or if a patient
wishes to rescind a previous decision to opt-out.
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 NC HIE patient record?
Your NC 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 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 NC HIE. For example, if one of your providers participates in
NC HIE, he or she can access your health information maintained by your other providers who also participate
in NC HIE.
How is my health information protected?
NC HIE takes every precaution to keep 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.
NC HIE tracks when your record is viewed, by whom, and what was looked at.
What can NC HIE do for me?
If you see multiple doctors who participate in NC 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.
I don’t want to participate. How can I opt out?
Your health information will be visible to your caregivers through NC HIE unless you opt-out using this form or
contact NC HIE at 1-855-926-1042. 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 NC and federal law. In cases of medical emergency, your doctor may request to view your
health record to diagnose or treat your emergency medical condition and NC HIE will make your records
available under such circumstances and will audit these requests. For more information about the emergency
medical exception to opting out, please visit Please allow up to two business days for
processing your opt out request.

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