If you do NOT want your patient records to be available to your doctors through the MHC network, you can complete an opt out form at your doctor/hospital or follow these steps to mail in your opt out form:

1. Print the appropriate form below and complete but do not sign,

2. Take it to a Notary,

3. Sign form in front of Notary,

4. Mail to MHC at PMB 270, 2000 E. Broadway, Columbia, MO 65201

Please note that you can opt in at anytime by following the opt in process found here.

ENGLISH OPT OUT FORM FOR PATIENTS

SOLICITUD DE EXCLUSION