A health information exchange (“Exchange”) is a way of allowing your health information to be electronically shared by participating medical groups, hospitals, labs, and other health care providers. The purpose of an Exchange is to give each of your participating providers, including Celly Health and our affiliated health system partners (“Celly Health”), the benefit of having access to your health information when providing healthcare to you.

Celly Health has agreed to participate in one or more Exchanges, and is requesting your consent to disclose your health information to, and access your health information from, these Exchanges. Your participation in such Exchanges is entirely voluntary. Please read the information below carefully before consenting.

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TYPES OF HEALTH INFORMATION INCLUDED IN THIS CONSENT: By selecting “I consent to share and access of my health information,” you voluntarily give Celly Health your permission to disclose all of your health information to, and access your health information from, the Exchanges in which Celly Health participates. Click here to see the list of Exchanges that we participate in, the Celly Health companies, and our affiliated health system partners. The types of health information that will be shared through the Exchanges include records and other information regarding your health from both before and after today's date, including diagnoses, treatment, hospitalizations, test results (like x-rays or laboratory), outpatient care, and medications prescribed to you. Such information may include sensitive health information such as mental health, substance use, and similar information.

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Yes, I consent to share and access of my health information
No, I do not consent to share and access of my health information

Please note that any health information previously shared with the Exchanges will remain with the providers who have accessed that information.