Can you opt out of automatic record sharing?

People often ask how to turn off the sharing of their medical records between providers. The honest answer is that “sharing” is not one thing. It happens at several layers, each with different rules, and the opt-out you want may exist at one layer and not at another.

Here is how to tell them apart.

Layer 1: disclosure for treatment

The base layer is the legal permission. Under the federal privacy rule, a covered entity may use and disclose your information for treatment, payment, and health care operations without obtaining your authorization first. That is the default the rest of the system is built on.

You may ask a provider to restrict disclosures under 45 CFR 164.522. With one exception they are not obliged to agree. The exception: if you pay in full out of pocket for a service, you can require that it not be disclosed to your health plan.

There is no general opt-out at this layer. Requests are possible, but the answer is usually no.

Layer 2: health information exchanges

The second layer is the regional or statewide health information exchange, and this is where opting out is most often genuinely available.

Many states operate or designate an HIE that aggregates records across participating organizations. State policy determines the consent model. Some operate on an opt-out basis, where you are included unless you file a form. Some require opt-in for all or for sensitive categories. Some have no statewide exchange at all. A few require separate consent for behavioral health or substance use data.

Because this is set state by state, there is no single form. To find yours, search for your state’s name with “health information exchange opt out”, and check your state health department site. What you are looking for is a named organization with a published patient consent policy and a downloadable form. Expect the opt-out to be per-exchange, not per-provider, and expect it to apply going forward rather than retroactively.

One consequence worth weighing before you file: the same exchange that makes your record visible to a stranger also makes it visible to the emergency department treating you while you are unconscious. Opting out is a real tradeoff, not a free win.

Layer 3: national networks

The third layer is national. Records also move through vendor networks and through the federal Trusted Exchange Framework and Common Agreement, which connects the large exchange networks to one another.

Patient-facing controls at this layer are thin and uneven, but they are not always absent. If your provider runs Epic, its patient portal is MyChart, and the exchange feature is called Care Everywhere. Some health systems expose a switch for it.

Look in your portal’s menu for a section called Sharing Hub, usually grouped under a heading like Sharing. It is easy to miss. On some deployments the sharing options are reachable mainly through the friends and family access screens, which is not where anyone looks for a privacy setting.

Inside it, you are looking for wording along the lines of Prevent organizations from requesting your health record, the mirror image of an Allow organizations to request your health record option. Duke Health publishes its full flow, which runs through several confirmation screens before it takes effect: limit sharing, then stop sharing with all organizations, then a final screen listing who still has access. Read that last screen rather than clicking past it.

Treat those labels as a description of what to look for, not as exact text. Every health system configures its own portal, and the wording differs. Some do not offer the setting at all. Cleveland Clinic’s public page on record sharing, for instance, describes Care Everywhere only as a way to link your accounts together and mentions no way to switch it off.

If there is no switch in your portal, ask anyway. Some organizations handle this on paper: Yale publishes a written request to restrict Care Everywhere. Put your request to the health information management department in writing. Do not assume the front desk knows.

Three things to be clear about before you flip it:

• This is Epic-specific. If your portal is not MyChart, you are on a different vendor, and none of these names will appear. The written request is your route.
• It is not retroactive. Switching off future sharing does not recall what has already been exchanged. Every organization that previously pulled your record keeps its copy.
• It cuts both ways. The same switch that blocks a stranger blocks the emergency department treating you while you are unconscious. That is the same tradeoff as the state exchange, with more of your record behind it.

Layer 4: things that are not covered at all

The federal privacy rule follows covered entities and their business associates. It does not follow your data everywhere it goes.

Consumer health apps, direct-to-consumer lab testing, wearables, and wellness programs are frequently outside it entirely. Their sharing is governed by their own privacy policy and by state consumer privacy law. The opt-out that matters here is usually the decision not to hand the data over in the first place.

What is realistic

Set expectations honestly:

• You can usually opt out of a state health information exchange, if your state has one.
• You can sometimes switch off cross-organization sharing in your patient portal, if your provider runs Epic and has chosen to expose the setting.
• You can usually not stop disclosure for treatment between the providers treating you.
• You can always exercise your right of access, under 45 CFR 164.524, and see what is actually in the record.
• Nothing you do now retracts copies already distributed.

A practical sequence: request your records from each system that has treated you, read the problem lists, correct what is wrong using the amendment process described in how a diagnosis follows you, then check your portal’s Sharing Hub and decide about your state exchange with the actual contents in front of you.

Why we build this

Opting out reduces what others can see. It does nothing to improve what you can see, and the two are separate problems.

HealthViewer is the second one. It pulls your results out of the portals that hold them, keeps them in an encrypted file on your own device, and gives you the long view of your own history that no single provider has. Nothing is uploaded to us, because there is no us to upload it to. See Privacy and Security for the specifics.

This post describes United States federal rules as of September 2026 and is general information, not legal advice. State law varies considerably, especially for mental health, substance use, HIV, and genetic information. Check your own state’s rules before relying on any of this.