Opt Out or Opt Back In

Opt Out – Request to Restrict Disclosure Of Health Information 

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.

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
Download the Opt Back In Form  (instructions are included on the form)

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.