Consent to Share Medical Information via Health Information Exchanges

Mayo Clinic participates in health information exchanges (HIEs)/record locator services that allow the electronic sharing of your medical information for treatment purposes.

What is a health information exchange (HIE)?

• An HIE is a way of sharing your health information among participating doctors’ offices, hospitals, labs, radiology centers, and other healthcare providers through secure, electronic means.
• Participating caregivers have the benefit of viewing the most recent information available from your other doctors when taking care of you.

What information is shared?

• Mayo Clinic will share the information in our medical record with other providers and caregivers.

What is the information used for?

• To help coordinate your care and treatment.
• To make sure that other providers have access to your records from Mayo Clinic electronically.

What are the benefits to me of participating?

• Your doctors will have access to most recent information to treat you. For example, your allergies and medications could be made available to an emergency room provider at a hospital where you have not previously been treated.
• When you change medications or receive new treatment, your providers will be made aware of these changes.
• Your care will be better coordinated.

What are the risks to me of opting out?

• Your provider may not have access to your most recent medical information such as your allergies and current medications in the event of a medical emergency.
• Your providers will have to obtain your medical records via fax or mail.

Can I change my choice?

• You can change your selection at any time by resubmitting this form.

Where can I learn more about how Mayo Clinic uses and shares my medical information?

• You can learn more about our policies for sharing medical information by reviewing our Notice of Privacy Practices, which is available online at mayoclinic.org/npp.

If you have any questions about data sharing, including data sharing via health information exchange (HIE),
contact the Mayo Clinic Privacy Officer by calling 507-266-6286 or sending an email to PRIVACYOFFICE@mayo.edu.