BHIX: Brooklyn Health Information Exchange

Forms (PDF format)

 Patient Consent Form

 Patient Withdrawal of Consent Form

 Educational Fact Sheet

 

How to Join

You will choose whether or not to Give Consent for each BHIX Participant to access your health information through BHIX.  To learn if the place where you receive care is currently a part of BHIX, please see our list of Participants. 

BHIX encourages you to talk to your provider(s) about health information exchange so that you understand what your participation in BHIX could mean for you. Surveys have shown that patients overwhelmingly support health information exchange, as long as they are properly educated about the security features, their rights and the benefits they can expect from participation. Please take your time to learn more about BHIX through the various materials available on this website and Contact Us if you have further questions.

Here's How To Join:

  1. Decide if you want a Participant to have access to your health information through the BHIX secure health information exchange. You can give certain Participants access and not others.  

  2. Complete a Patient Consent Form indicating you "Give Consent" to the BHIX Participant.

    You will be asked to fill out a BHIX Patient Consent Form during your next visit to a BHIX Participant. Patient Consent Forms are available at any BHIX Participant facility.

  3. For each BHIX Participant, complete a separate Patient Consent Form.

    Each Patient Consent Form can only authorize a single Participant to access your data. 

    A separate Patient Consent Form must be submitted to each additional Participant in order for that Participant to have access to your data.

  4. Give the completed Patient Consent Form to the BHIX Participant.

You May Change Your Mind At Any Time

If you wish to change your mind and prevent a Participant from having further routine access to your data, please fill-out and return a BHIX Withdrawal of Consent Form to your Participant’s facility. A copy of this form can also be obtained when you visit your Participant.

If you "Deny Consent"... Important Note About Emergencies

If you Deny Consent to a Participant by indicating that you Deny Consent on the Patient Consent Form, that Participant will not be able access your medical information through BHIX — even in an emergency.

Forms (PDF format)

Patient Overview Providers and Organizations Overview