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REVOCATION OF HEALTH INFORMATION EXCHANGE OPT-OUT From This form should only be used if you have previously opted out of participation in the HIE and now wish to opt back in to participation in the

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How to fill out ngdc-hie-opt-out-revocation-form

01

Download the ngdc-hie-opt-out-revocation-form from the official website or obtain a physical copy from the relevant healthcare facility.

02

Fill out your personal information including your name, date of birth, address, and contact information.

03

Indicate that you are opting out of the NGDC HIE by checking the appropriate box or providing a written statement.

04

Sign and date the form to confirm your decision to revoke consent for participation in the NGDC HIE.

05

Submit the completed form to the designated healthcare provider or organization handling the NGDC HIE opt-out requests.

Who needs ngdc-hie-opt-out-revocation-form?

01

Individuals who have previously consented to participate in the NGDC HIE but now wish to revoke their consent and opt out of the program.

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What is ngdc-hie-opt-out-revocation-form?

The ngdc-hie-opt-out-revocation-form is a document that allows individuals to revoke their previous decision to opt-out of the National Genetic Data Collection Health Information Exchange (NGDC HIE).

Who is required to file ngdc-hie-opt-out-revocation-form?

Individuals who previously opted out of the NGDC HIE and wish to reverse that decision are required to file the ngdc-hie-opt-out-revocation-form.

How to fill out ngdc-hie-opt-out-revocation-form?

To fill out the ngdc-hie-opt-out-revocation-form, individuals must provide personal information such as their full name, contact information, and specific details about their earlier opt-out choice.

What is the purpose of ngdc-hie-opt-out-revocation-form?

The purpose of the ngdc-hie-opt-out-revocation-form is to allow individuals to formally notify the authorities that they wish to opt back into the NGDC HIE after previously opting out.

What information must be reported on ngdc-hie-opt-out-revocation-form?

The form must report identifying information like the individual's name, address, and any relevant identification numbers associated with their prior opt-out status.

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