By signing below, I acknowledge and agree as follows:
- I wish to cancel my previous decision to opt-out of the HIE in which Royal Suites Healthcare and Rehabilitation Center participates. I understand that by making this decision I am authorizing my health information to be shared by Royal Suites Healthcare and Rehabilitation Center through this HIE.
- I understand that the information shared by ARoyal Suites Healthcare and Rehabilitation 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 Royal Suites Healthcare and Rehabilitation 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 Royal Suites Healthcare and Rehabilitation Center to take effect.