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TRENTON HIE OPT OUT FORM Name: ___ Date of Birth: ___ / ___ / ___ Street Address: ___ City: ___ State: ___ Zip: ___ Phone: ___ Email Address: ___ I hereby acknowledge and agree as follows: 1. I WISH

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How to fill out trenton hie opt-out form

01

Download the Trenton HIE opt-out form from their website.

02

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

03

Indicate that you do not wish to participate in the Trenton HIE by checking the opt-out box.

04

Sign and date the form.

05

Submit the form either by mail or in person to the Trenton HIE office.

Who needs trenton hie opt-out form?

01

Individuals who do not want their health information to be shared or accessed through the Trenton Health Information Exchange.

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What is trenton hie opt-out form?

The Trenton HIE opt-out form is a document that allows individuals to choose not to participate in the Trenton Health Information Exchange.

Who is required to file trenton hie opt-out form?

Any individual who does not wish to have their health information shared through the Trenton HIE is required to file the opt-out form.

How to fill out trenton hie opt-out form?

To fill out the Trenton HIE opt-out form, individuals must provide their personal information and sign to indicate their decision not to participate in the exchange.

What is the purpose of trenton hie opt-out form?

The purpose of the Trenton HIE opt-out form is to give individuals control over the sharing of their health information and to respect their privacy preferences.

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

The Trenton HIE opt-out form typically requires the individual's name, contact information, and a signature to confirm their decision.

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