Health Information Exchange

My Community Health Center participates in one or more Health Information Exchanges. Your healthcare provider can use this electronic network to securely provide access to your health records for a better picture of your health needs. We and other healthcare providers may allow access to your health information through the Health Information Exchange for treatment, payment, or other healthcare operations.

This is a voluntary agreement. You may opt-out at any time.

To opt-out please complete a notarized copy of the form below and email it to
If you prefer to print the form, you can bring it to the office and sign it in front of My Community Health Center staff.

Clinisync HIE - Request to Change Consent Form