Thank you for choosing Sidney Regional Medical Center. Our goal is for you to receive the best care possible so you can return to optimal health. As part of your continuum of care, SRMC is participating in Commonwell, a service that allows the network of participants to securely identify, send and receive your accurate and approved medical information. This free service is offered so your health information can be quickly and securely available to your doctors who are part of the SRMC.
Your protected health information will be available to participants of Commonwell. Your enrollment will bring you better care with fewer delays, fewer hassles and greater peace of mind. With timely access to information from other doctor's you have seen, your doctors can make the best decisions possible to optimize your health.
I hereby refuse consent to authorize SRMC to disclose information related to my visit to the CommonWell Network. I understand that the purpose of this disclosure is for continuity of care. Furthermore, I release Sidney Regional Medical Center, its employees, and the providers from any liability that may arise as a result of my refusal to fill opt in the CommonWell program.