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CANCELLATION OF PRIOR CAMDEN COALITION HIE OPT-OUT FORM Name___ Date of Birth ___/___/___ Street Address: ___ City: ___ State:___ Zip:___ Phone:___ Email:___ I hereby acknowledge and agree as follows:

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How to fill out hie cancel prior opt-out

01

Contact the HIE organization where you previously opted-in for cancellation process

02

Provide necessary information such as your name, date of birth, and any other identifying information

03

Follow any specific instructions provided by the HIE organization to complete the cancellation process

Who needs hie cancel prior opt-out?

01

Individuals who have previously opted-in for HIE (Health Information Exchange) but now wish to cancel their participation

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What is hie cancel prior opt-out?

HIE cancel prior opt-out is a process where individuals or entities can request to be removed from a health information exchange (HIE) network.

Who is required to file hie cancel prior opt-out?

Any individual or entity that does not want their health information to be shared through a HIE network is required to file a hie cancel prior opt-out.

How to fill out hie cancel prior opt-out?

To fill out a hie cancel prior opt-out, individuals or entities can usually submit a form to the HIE network or contact them directly to request removal.

What is the purpose of hie cancel prior opt-out?

The purpose of hie cancel prior opt-out is to give individuals or entities control over who has access to their health information and to protect their privacy.

What information must be reported on hie cancel prior opt-out?

The information required to be reported on hie cancel prior opt-out typically includes the individual or entity's identifying information and a statement requesting removal from the HIE network.

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