For Patients

Patient Consent for Clinical Data Exchange

It's Your Decision

  • Patients’ health information will automatically be included in PSJH Clinical Data Exchange. If patient does not wish to participate in sharing their information, they must “opt out” by completing the PSJH-ClinicalDataExchange-OptOut-Form. Consent forms can be submitted online (forms available under Patient Consent Forms section) or downloaded here.
  • Patients can choose to change their decision at any time by completing the PSJH-ClinicalDataExchange-Revocation-OptOut-Form.
  • Consent and Revocation forms can be sent directly to the PSJH CLinical Data Exchange department via postal, email, or fax. If you have any questions, please do not hesitate to call us at: (714) 937-6249 or toll free at (833) 990-1900.

Consent Forms

For your convenience, you may complete, sign, and submit your consent form online using the appropriate link. You may also submit your request via email, fax, or postal mail by downloading the form using the icon.
Click here to goto Forms section.

Clinical Data Exchange Benefits

Improve patient safety by reducing medication errors

Labs and Radiology reports can be shared with your health providers

Improve patient coordination by sharing clinical data with your care team

Clinical data follows you across all of your providers

Securely share clinical data with your providers

Cut down on patient paperwork

FAQs

What is Health Information Exchange (HIE)?

HIE is the electronic sharing of health-related patient data among providers and health facilities for coordination of care.

What patient information is shared?

  • Admission, Discharge, & Transfer (ADT)
  • Allergies
  • Medications
  • Problem/History
  • Result Report (Lab, Radiology, & ITS)

Is the HIE connection secure?

  • Connection to the HIE network is secured through either the use of a Virtual Private Network (VPN) and/or over the internet using SSL encryption and SAML
  • All data communicated between the providers are encrypted through a dedicated connection protocol
  • All access to Providence HIE is password protected
  • HIE is HIPAA compliant

Who can view my patient data?

Only the care team can access the patient data.

Patient Consent Forms

ENGLISH

Opt Out Form

Revocation Opt Out Form

SPANISH

Opt Out Form

Revocation Opt Out Form

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