Opt Out – Request to Restrict Disclosure Of Health Information
IHDE adopts the consent policy of the state of Idaho. In a Full Opt-Out model, patients’ information is included in the Exchange by default and is available for providers unless the patient proactively opts out. Under the full opt-out model, if a patient does not opt out, all of his or her health information that is not subject to special protections under existing law, will be available to share across treating providers. If the patient does opt out, none of his or her information will be available for exchange. It is an “all-or-nothing” proposition.
Before you Opt-Out, please read the Patient Benefits page to make sure you understand the benefits of having patient health information available through IHDE.
You must read, understand and accept these stipulations in order to officially opt out. You must print and sign your form, found below, to indicate your acceptance.
1. I UNDERSTAND that this request only applies to sharing my health information through Idaho Health Data Exchange. I UNDERSTAND that when I see a health care provider for treatment, that provider may request and receive my medical information from other providers using other methods permitted by law, such as fax or mail. I am aware that health care providers who originally recorded information about me may continue to have access to this information through means other than IHDE.
2. I UNDERSTAND that once my opt-out request goes into effect, it will remain in effect unless I change it in writing by submitting an opt-back-in request to IHDE via an Opt-In Form below.
3. I have had an opportunity to ask and receive answers to all my questions about opting out of IHDE.
4. Any information that is disclosed before I submit this opt-out request cannot be taken back and may remain with my provider if he/she accessed such information before this request went into effect.
5. This request, and any future request to opt back in, can take up to three business days after receipt by IHDE to take effect.
6. I UNDERSTAND that this IHDE opt-out request does NOT cover or affect my opting out of any other health information exchanges, including other exchange technologies offered by IHDE.
7. I UNDERSTAND that if I wish to opt out of another health information exchange, I must follow the instructions of the other such exchanges to limit my participation.
8. I UNDERSTAND and accept the risks associated with denying health care providers access to my health information through IHDE.
9. I UNDERSTAND that I can revoke this request at any time.
Download the Opt Out Form
(instructions are included on the form)
Download Spanish Opt Out Form – Descargar Formulario español Opt Out
If you’ve chosen to Restrict Disclosure of Health Information (opt out) through the IHDE, download the form above, print, complete, and mail or fax it to the IHDE (address and fax is listed on the form). Once your request is received at the IHDE, allow 7-10 business days for it to be processed.
Opt Back In – Request to Rescind
If you’ve chosen to rescind your request to Restrict Disclosure of Health Information (opt back in) through the IHDE, download, print, complete, and mail or fax it to the IHDE. The form must be notarized.