KNOWLEDGE OF THE HEALTH INFORMATION EXCHANGE (HIE)
Providers affiliated with Beth Israel Deaconess Medical Center (BIDMC) and other doctors who participate with the Beth Israel Deaconess Care Organization (BIDCO) participate in Health Information Exchange (HIE). The HIE is a secure computer network that, with my permission, will allow my BIDMC and BIDCO providers to view all of my health information (medical records). The HIE protects the confidentiality, privacy and security of the information. By making my health information available electronically, my BIDMC and BIDCO providers will be able to better coordinate my care. By signing this form,
- I am aware of the BIDMC and BIDCO providers to view my health information electronically via the HIE. I agree to the release of all my health information, including sensitive information, to my BIDMC and BIDCO providers through HIE. I understand that my health information may contain (now or in the future) certain types of sensitive information.
- HIV/ AIDS
- Genetic testing
- Substance abuse (drug and alcohol)
- Mental health treatment
- Sexually transmitted diseases
- Sexual assault/ Rape
- Domestic abuse
- Abortion
- I understand that BIDMC, BIDCO, and my health care provider have taken reasonable steps to protect my confidentiality. This authorization will stay in effect from the date of my signature below until my provider no longer participates in HIE. I have the right to take back my consent or opt-out in writing at any time. My revocation will be effective once IGIC receives it.
I have read this authorization form and I understand what it says. All of my questions have been answered in a language that I understand. I agree with the information on this form. By signing this form I authorize my health care provider to use or disclose my health information in order to participate in the HIE.