This form should be completed by consumers who want to participate in HealthShare Exchange (HSX), the Health Information Exchange (HIE), after they previously opted out of it.

Health information exchange is the electronic sharing of health information between participating healthcare providers in a way that ensures the secure exchange of health information to provide care to patients.

By submitting this Opt Back In Form, health information about you will be accessible to healthcare providers and other authorized users through the HIE. This form supersedes any previously submitted Opt Out Forms to HSX. Therefore, HSX participants who search for information about you will receive healthcare information upon request.

You can reach HSX at any time by calling (855) 479-7372 or email