Request Non-Participation
Use this form if you do not want your medical information to be accessible to authorized healthcare providers through DHIN.
Opt-Outs
Use the forms below to request non-participation in DHIN or to restore participation after a previous opt-out.
Participation Changes
DHIN allows patients to request non-participation or to restore participation after a previous opt-out. Choose the form that matches your request and follow the instructions included with the document.
Cancel a Non-Participation Request
Use this form if you previously opted out of DHIN and want to restore participation.