[
Instructions for Provider
Instructions for Physician Office
Acknowledgement of Notice of
Privacy Practices – English
Acknowledgement of Notice of
Privacy Practices – Spanish
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
Exclusión 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
Anulación de Exclusión Voluntaria