Patient/Client Opt Out

To opt out of data sharing, please download and complete  form (Word English | Spanish & PDF English | Spanish ) and submit to CalMHSA by email at [email protected]. Proof of identification and authorization are required.  

Your choice to opt out of the Health Information Exchange will not affect your ability to access medical care. Opting out will not prevent your caregivers from sharing your health information with authorized entities when necessary for public health or research purposes that are permitted or required by federal and state law. In cases of medical emergency, your doctor may request to view your health record to diagnose or treat your emergency medical condition, and CalMHSA will make your records available under such circumstances.