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Your emergency care summary OPT-OUT FORM CONFIDENTIAL Request for my clinical information to be withheld from the Summary Care Record If you DO NOT want a Summary Care Record please fill out the form
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How to fill out summary care record opt:

01
Visit the designated website or app for summary care record opt.
02
Provide your personal information, such as name, date of birth, and address.
03
Follow the prompts to select your preferences for opting in or out of summary care record.
04
Review the terms and conditions before submitting your decision.

Who needs summary care record opt:

01
Individuals who want their healthcare information to be accessible to medical professionals in case of an emergency.
02
Patients who have complex medical conditions or are on multiple medications.
03
People who frequently visit different healthcare providers and want to ensure their medical history is easily accessible.
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