Consent to Participate in the Health Information Exchange

WHAT IS A HEALTH INFORMATION EXCHANGE?

A Health Information Exchange (HIE) allows your doctors, hospitals, pharmacies, and other healthcare providers to securely share your medical information electronically. This means your healthcare team can quickly access your health records when they need them to provide you with better care.

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‍WHAT IS TEFCA?

The Trusted Exchange Framework and Common Agreement (TEFCA) is a nationwide network that connects different health information systems. It was created by the U.S. government to help healthcare providers across the country share patient information safely and securely.

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CARE FOR HEARTS MEDICAL GROUP OFFERS ACCESS TO TEFCA.

As a Care for Hearts Medical Group patient, you may permit us to share your health information with, and access health information from, other providers who are connected to the TEFCA network.

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BENEFITS OF PARTICIPATING WITH THE TEFCA NETWORK.

• Your connected doctors will have access to your complete health picture
• Faster, more coordinated care
• Reduced duplicate tests and procedures
• Better medication management
• Improved care during emergencies

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TYPES OF HEALTH INFORMATION THAT MAY BE SHARED.

With your consent, the following types of health information may be shared through the TEFCA network:

• Medical history and diagnoses
• Current medications and allergies
• Blood pressure readings and trends
• Heart rate measurements
• Medication adherence data
• Health goals and progress
• Wellness activities and lifestyle information
• AI-generated health insights and alerts

• Telehealth consultation notes
• Pharmacist recommendations
• Cardiologist oversight reports
• Treatment plans and care coordination notes
• Lab results and test reports
• Insurance and billing information

Information That Care for Hearts will NOT share:

• Information you specifically ask us not to share
• Psychotherapy notes (unless specifically authorized)
• Marketing or non-medical communications
• Mental health and substance abuse treatment records
• HIV/AIDS related information
• Genetic testing results
• Reproductive health information

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PURPOSES FOR SHARING MEDICAL RECORDS.

With your consent, your health information may be shared for the following purposes:

Treatment and Care Coordination:

• Providing medical care and treatment
• Coordinating care between your healthcare providers
• Managing chronic conditions like heart disease
• Medication management and safety checks
• Emergency medical care

Healthcare Operations:

• Quality improvement activities, including developing and improving the Artificial Intelligence tools that assist our providers
• Patient safety initiatives
• Care management programs
• Population health management

Public Health and Safety:

• Required reporting to public health authorities
• Disease surveillance and prevention
• Emergency preparedness and response

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WHO MAY ACCESS THE SHARED INFORMATION?

The following types of healthcare providers and organizations may access your shared health information:

• Your doctors, nurses, and other healthcare providers
• Hospitals and emergency departments
• Pharmacies and pharmacists
• Laboratories and imaging centers
• Health insurance plans (for treatment and payment purposes)
• Public health authorities (when required by law)
• Healthcare quality organizations
• Other TEFCA-participating organizations involved in your care

Access is limited to:

• Healthcare professionals with a treatment relationship with you
• Authorized personnel who need the information for your care
• Emergency situations where immediate access may save your life

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YOUR RIGHTS AND CHOICES.

You have the right to:

Participate or Not Participate:

• Participation in health information exchange is voluntary
• You can choose not to participate without affecting your care at Care for Hearts
• You can change your mind at any time

Control Your Information:

• Request to see what information has been shared about you
• Ask for corrections to incorrect information
• Restrict sharing of certain types of information
• Opt out of sharing for specific purposes

Access Your Records:

• View your health information through the TEFCA network
• Request copies of your medical records
• Get information about who has accessed your records

Special Protections:

• Mental health, substance abuse, and HIV/AIDS information requires separate authorization
• You can choose to exclude sensitive information from sharing
• Genetic information has additional protections under federal law

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SECURITY AND PRIVACY PROTECTIONS

Your health information is protected by:

Federal Laws:

• HIPAA Privacy and Security Rules
• 21st Century Cures Act
• HITECH Act requirements

Technical Safeguards:

• Encryption of all transmitted data
• Secure authentication for all users
• Audit logs tracking all access to your information
• Regular security monitoring and updates

Administrative Safeguards:

• Training for all personnel with access to your information
• Background checks for authorized users
• Policies limiting access to only necessary information
• Regular compliance monitoring

Physical Safeguards:

• Secure data centers and facilities
• Controlled access to computer systems
• Secure disposal of electronic media

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CONSENT DURATION AND REVOCATION PROCEDURES

How Long This Consent Lasts:

• This consent remains in effect until you revoke it
• If you do not revoke your consent, it will remain in effect for the duration of your treatment with Care for Hearts

How to Revoke (Cancel) This Consent: You may revoke this consent at any time by:

• Calling Care for Hearts Member Services at XXXX
• Sending written notice to: Care for Hearts Privacy Office, 545 Middlefield Rd #220, Menlo Park, CA 94025
• Emailing: privacy@careforhearts.com
• Logging into your app and updating your privacy preferences

Important Information About Revocation:

• Revocation will not affect information already shared before your revocation
• Revocation may limit your healthcare providers' ability to coordinate your care
• You can still receive care from Care for Hearts if you revoke this consent
• Emergency access to your information may still occur to save your life

Partial Revocation: You may also choose to:

• Limit sharing to only certain types of information
• Restrict sharing to specific healthcare providers
• Opt out of sharing for certain purposes while allowing others

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ACKNOWLEDGMENTS

Patient Acknowledgment: I acknowledge that I have read and understand this consent form. I understand that:

• Participation in health information exchange is voluntary
• I can revoke this consent at any time
• My treatment will not be affected if I choose not to participate
• I have received a copy of Care for Heart's Notice of Privacy Practices