Request to Participate in the Health Information Exchange

Complete the form below to get started as a new participating organization. To learn more about our services and understanding what will work best for your team, check out our Health Information Exchange Services page.

This form is for organizations interested in participating in the Health Information Exchange. If you are not sure whether certain questions apply to your organization, do not hesitate to contact us! We will help you fill it out correctly and completely.

If your organization already participates and you're looking to get access to services, please submit a New User Request through this link.

If you are a patient looking for information, please reach out to support@healtheconnections.org for assistance or call 315-671-2241 x5.

Organization Information





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Primary Location










Primary Contact






Provide the name, title, and email of the individual authorized to sign contracts for your organization, if different from the primary contact above
Enter the name, title, and email address of the individual authorized to sign contracts for your organization, if different from the primary contact above.


Additional Information




Safety net practices are defined by the Institute of Medicine (IOM) as “those providers that organize and deliver a significant level of health care and other needed services to uninsured, Medicaid and other vulnerable patients.



Patient Centered Medical Home (PCMH) is a model of care where each patient has an ongoing relationship with a personal physician and a care team.



Generally, a Covered Entity can be described as one of the following:

  • Is a healthcare provider, clearinghouse, or health plan.
  • Processes, or facilitates the processing of, health information from nonstandard format or content into standard format or consent or from standard format or content into nonstandard format.
  • Provides, or pays for the cost of, medical care.
  • Transmits (sends) any covered transactions electronically or uses a business associate to perform this function.




Health Information Network Participation


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Services Interested In

Community-wide Patient Lookup
View consolidated patient medical records in the Provider Portal, including lab and image reports.

Results
Summary view of clinical results in the Provider Portal, where a provider is named.

Secure Messaging
Exchange clinical data through secure mail.

Statewide Encounter Alerting
Patient activity notifications sent to providers for Emergency Department encounters, in-patient hospital admissions and discharges.

Results Delivery
Automated delivery of patient records where provider is “named” to connected EHR's.

Sending and Receiving CCDs
Exchange of patient records between HealtheConnections and connected EHR's.



Enter any additional information regarding your request for participation that you feel relevant.