Providers who participate in Kansas Health Information Exchange use electronic health records (EHRs) instead of paper medical records to maintain personal health information. Under Kansas law, you have the right to restrict access to your electronic health records through the exchange. If you choose to restrict access, or Opt Out, your information will always be available on your own health care provider’s electronic health record and may be shared with other health care providers by traditional methods. The forms required to restrict access, or Opt Out, follow.
Request for Restrictions on Access
to Health Information Form
Click on the picture below to open and print the form.
To restrict access to your health information (opt out), complete the printed form and mail to: