Opt Out of the TriCore Portal HIE

OPT OUT INFORMATION

A Health Information Exchange, or HIE, is a way of allowing your health information to be accessed through a secure, electronic network by your doctors, hospitals, and other health care providers that provide care to you. TriCore Reference Labs has established this HIE to give your healthcare providers access to your lab tests and other health information about you to improve your care. This means that information that could help save your life in a medical emergency will be available to your health care providers that participate in the TriCore HIE.

If you do not want your health care providers to have access to your health information in the TriCore HIE, you can chose to “opt out” of having your information being made available through the HIE. You can opt out by completing the form below, called an “Opt Out Request” and submitting through this page. If you request a mail confirmation, a copy of this request will be mailed to you. If you fill out the Opt Out Request Form, you understand that:

  1. TriCore will not allow access to your health information that TriCore holds about you. This means that your health information will not be available through the TriCore HIE, even in an emergency. As a result, you must agree to waive any claims against TriCore or the HIE participants for any harm caused by the exclusion of your information from the TriCore HIE.
  2. Your health care providers can still receive your lab test results and other medical information that TriCore holds about you through other methods such as fax, mail or other forms of communication.

Your request to opt out of the TriCore HIE will be effective once we have received and processed the completed Opt Out Request, and in no event later than thirty (30) days from our receipt of your completed Opt Out Request. Your request to opt out of the TriCore HIE will not apply to any health information sent through the HIE before the date that we have completed processing your Opt Out Request and your opt out becomes effective.

Please fill out the form below to either Opt Out or Rescind your Opt Out Revocation from the TriCore Portal.

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CONFIRMATION METHODS

Email: After receiving and processing your request, you will be emailed with a final confirmation of your information with a link to submit and finalize your request.

Phone: After receiving and processing your request, you will be called at the number provided to confirm your information and approval to finalize your request.

Mailed Letter: After receiving and processing your request, you will be mailed a copy of your request which will need to be signed by the responsible party and returned to TriCore either by fax or mail.

UNDERSTANDING YOUR REQUEST

  • NONE of your health care providers will be able to access your health information maintained in the TriCore HIE, even in case of a medical emergency. You understand that this may put you at risk.
  • This Opt Out Request only applies to your health care providers being able to access your health information through the TriCore HIE. Your Opt Out Request does not apply to stop your health care providers from requesting and receiving your health information from TriCore using other methods, such as fax, telephone, email, or mail.
  • This Opt Out request does NOT mean that you are opting out of any other HIE. You understand that if you wish to opt out of another HIE, you must communicate with each of your health care providers participating in such other HIE about how you can do that.
  • Your HIE Opt Out request will remain in effect unless you change it in writing.
  • Any information that is disclosed before you submit this Opt Out Request cannot be taken back
  • You agree that you waive any claims against TriCore or the HIE participants for any harm caused by the exclusion of your information from the TriCore HIE.

QUESTIONS?

Call us at 505.938.8922