By signing below, I acknowledge and agree as follows:
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I wish to opt-out of the HIE in which Hunterdon Care Center participates. I understand that by making this decision my health information will not be shared by Hunterdon Care Center through these HIE(s) to any HIE participants (outside of Hunterdon Care Center} involved in my care, even in cases of a medical emergency.
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I understand that opting out of the HIE
does
not
prohibit
Hunterdon Care Center
from sharing my information with others
involved in my care, as permitted by law, by methods other than the HIE, such as by phone, fax, mail, secure email or other
electronic
communications.
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I understand that this HIE Opt
-
Out Form only prohibits Hunterdon
Care Center
from sharing my health information through
the HIE that -
Hunterdon Care Center
participates in. I understand that my non-
Hunterdon Care Center
health care providers
may also participate in HIEs. If I wish to opt
-
out of HIEs my other
health car
e
providers participate in, I am responsible for
contacting each of my other
health care providers for information on how to opt-
out.
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I understand that this opt-out will remain in effect unless I choose to opt back in. I may opt back in at any time by completing Hunterdon Care Center Cancellation of Health Information Exchange (HIE) Opt-Out Form and submitting as indicated on the form.
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This opt
-
out may take up to five (5) business days after receipt by Hunterdon Care Center
to take
effect.
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This opt-out does not apply to any of your health information shared by Hunterdon Care Center through the HIEs before this opt-out takes effect.