Information Sharing Authorization

The Information Sharing Authorization (ISA) is an electronic and paper form that accompanies and supports the use of the Community Health Record (CHR), now known as AC Care Connect, and Social Health Information Exchange (SHIE). The ISA is a tool that helps improve care coordination and health outcomes for consumers.

The form allows consumers to consent to sharing of their medical and mental health, housing, social services and jail health information with and between the SHIE/CHR partner organizations working with that consumer, as allowed by Federal and State regulations.

 

To learn more, download this two-page summary document. (2/1/2021: In progress of updating document)

Each of the fillable Information Sharing Authorization forms below include a set of instructions for the provider. Please read them closely before having the consumer or an authorized representative sign the ISA.

English ISA

Spanish ISA

Arabic ISA

Chinese ISA

Mam ISA

Punjabi ISA

Tagalog ISA

Vietnamese ISA