Documents

OPT-OUT Form

This form is to be used by patients who do not wish to participate in Rio Grande Valley Health Information Exchange (RGV HIE).

RGV HIE OPT-Out Request Form English

RGV HIE Opt-Out Request Form Spanish RGV HIE Solicitud de Exclusion Voluntaria

Want to Reapply and OPT-back into the HIE

Even if you choose to opt-out of the HIE now, you may change your mind at any time and opt back in to the exchange by downloading the Opt-In form here and either giving it to your Provider or mailing it to 1816 East Harrison Ave. Ste. A, Harlingen, Texas 78550.

RGV HIE Revocation Opt-Out Form English 

RGV HIE Opt Out Form Revocation Spanish RGV HIE Solicitud de Revocacion de Exclusion VoluntariaSpanish RGV HIE Solicitud de Revocacion de Exclusion Voluntaria