Health Information Exchange (HIE) Consent

In this consent form, you can choose whether to allow Clara Health Medical Services, PA, Clara Health Medical Services West, PC, Clara Health Medical Services East, PC, Clara Health Medical Services Northwest, PC and Clara Health Medical Services Midwest PA (collectively, “Clara Health”) to share your medical records with your non-Clara Health providers and to allow Clara Health to access information about care provided to you by non-Clara Health providers through information technology platforms, including CommonWell, Carequality, and eHealth Exchange.

These platforms can help collect the electronic health records you have in different places where you receive healthcare services and make them available electronically and securely to the providers treating you in an effort to improve the quality of your healthcare services. More information can be found directly on the CommonWell, Carequality, and eHealth Exchange sites.

Your Consent

Your consent to HIE participation is voluntary. By checking the HIE consent checkbox during enrollment, you are affirmatively consenting to the sharing of your health information through the HIE as described in this form. If you do not consent, your information will not be shared through the HIE.

Your decision:

  • Does not affect your access to care
  • Can be withdrawn at any time

What Information May Be Shared

If you consent, the following information may be shared securely with authorized HIE participants involved in your care:

  • Name, date of birth, and other identifiers
  • Diagnoses and medical history
  • Medications, allergies, and immunizations
  • Laboratory and imaging results
  • Clinical notes and care summaries
  • Other information necessary for treatment, payment, or health care operations

Sensitive Information

Certain sensitive information (such as psychotherapy notes, substance use disorder records, reproductive health data, genetic information, or HIV status) is protected by additional federal or state laws and will only be shared when permitted or when you provide specific authorization, as required by law.

Why We Share Through the HIE

Your information may be accessed through the HIE to:

  • Improve coordination between your health care providers
  • Support safe, timely, and informed treatment decisions
  • Reduce duplicate tests and procedures
  • Improve care during emergencies or when you receive care outside our organization

How Your Information Is Protected

All HIE participants are required to comply with applicable privacy and security laws, including HIPAA.

Safeguards include:

  • Secure electronic transmission
  • Role-based access controls
  • Audit logs and monitoring
  • Use of information only for permitted purposes (such as treatment)

Health information is not sold and is not used for marketing without your authorization.

Your Right to Withdraw Consent

You have the right to withdraw your consent to HIE participation at any time.

If you withdraw consent:

  • Your information will not be shared with other organizations through the HIE going forward
  • Providers outside of our organization may not be able to see your prior records
  • Information already accessed may remain part of a provider's medical record
  • Certain disclosures may still occur if required by law (e.g., public health reporting)

How to Withdraw Consent

To withdraw your consent to HIE sharing, you may:

Withdrawal requests are processed as quickly as possible, though it may take a short period for all systems to reflect your choice.

Changing Your Decision

You may re-consent at any time by submitting a written request or updating your preference through available channels.

Legal Disclosures

Even if you withdraw consent, we may still disclose health information when required or permitted by law, including:

  • Public health reporting
  • Emergency situations
  • Court orders or legal requirements