Opt-Out Form for MNEAS

This form is to be used by patients who do not wish to participate in Minnesota’s Encounter Alert Service (EAS).

Please be advised that opting out does not preclude any participating organization that has received or accessed PHI via EAS prior to such opt-out, and incorporated such PHI into its records, from retaining such information in its records.

This opt-out form only needs to be completed once to opt out of EAS; it is not necessary to complete for each provider. If you do not live in Minnesota but still receive care in the region, you should complete this form if you wish to opt out.