AoD Request Form V3

What health information rights do I have?

State and federal laws give you specific rights about your health data and whether it is shared through CRISP. You have the right to:

• Request a list of people who have viewed your health care information;

• Opt-out of CRISP

• Be notified if your information has been viewed by an unauthorized person;


Can I opt-out of CRISP?

You can decide whether or not CRISP shares your health information. You can opt-out of CRISP at any time. If you opt-out, doctors and nurses will not be able to search for your health records through the HIE and your information will not be available in an emergency. Your records will not be available for research or quality improvement. Any information that a doctor may have seen in CRISP and entered into your medical record before you opted out will stay in your medical record with that doctor but will not be shared through CRISP.


If you opt-out of CRISP your health care providers will not be able to see your information.

Your doctors will still be able to select CRISP to get your data sent directly to them from labs. Also, Maryland law does not allow you to opt-out of public health reporting, such as the reporting of specific diseases to public health officials. CRISP is required to make these reports even if you have opted out. The Maryland Prescription Drug Monitoring Program (PDMP) is also required, so you may not opt-out.

How do I know who has seen my information?

You have the right to see a list of all the providers that have viewed your records and when they viewed them. Complete and submit this form to request the list.

Will I know if my data is misused?

CRISP is looking out for the security of your information and will quickly look into any issues that the security team notices. State and federal law require CRISP to notify the doctor who shared the information with CRISP if it may have been viewed by an unauthorized person. The law also requires that doctor to notify you if this happens.

If you have any questions about CRISP Privacy and Security Policies, you can contact Brandon Neiswender via email brandon.neiswender@

How do I Opt Out

Call 1.877.952.7477

Fax your completed form to 443.817.9587

Mail your completed form to:

CRISP, 7160 Columbia Gateway Drive, Suite 100 Columbia, MD 21046