By signing below, I acknowledge and agree as follows:
I wish to cancel my previous decision to opt-out of the HIE in which Hunterdon Care Center participates. I
understand that by making this decision I am authorizing my health information to be shared by
Hunterdon Care Center through this HIE.
I understand that the information shared by Hunterdon Care Center may include information of a more
sensitive nature, including but not limited to: genetic diseases or tests, substance use disorder, mental
health conditions, acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV),
sexually transmitted diseases (STDs), and birth control and abortion (family planning).
I understand that if I change my mind after opting back in, I may at any time later opt back out of the
HIE in which Hunterdon Care Center participates by completing and submitting a new Health
Information Exchange (HIE) Opt-Out Form as indicated on the form.
This cancellation of opt-out request can take up to five (5) business days after receipt by Hunterdon