The medical groups, hospitals, and other healthcare-related entities (Participants) who care for you and related parties who pay for such healthcare services share your health information through Carolina eHealth Network, a secure, electronic Health Information Exchange (HIE)* unless you Opt-Out of Carolina eHealth Network.
If you do not want your health information shared and used through the HIE, complete and submit the form below. By submitting this completed Opt-Out Form you understand and agree that:
If there are any questions in the processing of your request, a Carolina eHealth Network representative will contact you using the telephone number you provided below.
*Carolina eHealth Network is the Health Information Exchange endorsed by the South Carolina Medical Association and operated by KAMMCO.
ALL FORM FIELDS BELOW ARE REQUIRED UNLESS NOTED "OPTIONAL."