![]() ![]() NOTICE: If you send health information to Cleveland Clinic via email, please know that your message may be sent in an unencrypted email. ![]() First and last name (and middle name, if applicable).Include all of the following with your request so we can be sure to identify the correct medical information to restrict from all the Health Information Exchanges that Cleveland Clinic participate in: Mail your written request, signed and dated to the Cleveland Clinic Privacy Office, 9500 Euclid Ave/DD2-20, Cleveland, OH 44195.Send your request via email to with “ Opt-Out” in the subject line OR.You may opt out of the health information exchanges by doing one of the following: If that facility also participates in the same HIE’s as Cleveland Clinic, Cleveland Clinic may be able to access and share your health information with these other participants for treatment purposes and for payment of treatment services.įor more information and to view participating healthcare organizations, please visit the health exchange partnership websites below: Please notify your healthcare team at your appointment that you have been seen at another facility. This means that wherever a patient goes, the patient’s health information may be available to all doctors who use the HIE’s, which helps to provide safer, more coordinated patient care. The goal of the HIE’s is to help participating physicians and providers give better, more efficient care to their patients by the sharing of health information across secure systems. These HIE’s allow any health information organization that participates in the HIE’s to have secure electronic access to their patients’ records. A full list of these arrangements can be found on our Notice of Privacy Practices website.Ĭleveland Clinic’s participation in HIE’s helps enhance the quality of your care. Health Information Exchanges with other OrganizationsĪs described in the Cleveland Clinic Notice of Privacy Practices, Cleveland Clinic participates in certain health information exchanges (HIE’s) whereby we may disclose your health information, as permitted by law, to other health care providers or entities for treatment, payment, or health care operations purposes. Please complete the form and send it to your non Cleveland Clinic provider for processing. To give Cleveland Clinic access to outside medical records, you will need to authorize release from your current medical provider(s). Request information from other facilities to be released to Cleveland Clinic:Īuthorization for the Release of Medical Information From Other Healthcare FacilitiesĪuthorization for the Release of Medical Information From Other Healthcare Facilities (Spanish) After the form is signed and dated, fax the information to the number indicated at the bottom of the form or mail it to the address indicated.įor radiology image requests, please allow 48 hours. ![]()
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