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** *PRINT Practice Name Here* CARE EVERYWHERE HEALTH, HEALTH INFORMATION EXCHANGE, CARE EVERYWHERE AND HEALTH CONSENT FORM MAN ID Patient MAN/Patent ID: 9178292096 Please Fax signed consents to: 9178292096

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What is care everywhere?

Care Everywhere is a secure way to exchange patient health information electronically between different healthcare organizations.

Who is required to file care everywhere?

Healthcare providers, hospitals, and other healthcare organizations that participate in the Care Everywhere network are required to file care everywhere.

How to fill out care everywhere?

Care Everywhere is filled out using electronic health record systems that are connected to the network. Providers input patient information and request data from other healthcare organizations.

What is the purpose of care everywhere?

The purpose of Care Everywhere is to improve coordination of care, enhance patient safety, and provide healthcare providers with access to up-to-date patient information.

What information must be reported on care everywhere?

Patient demographics, medical history, medications, allergies, lab results, and other pertinent health information must be reported on Care Everywhere.