Skip to main content
NC HIEA logo NC HIEA

Topical Navigation

  • Home
  • For Patients
    For Patients
    • News About Your Medical Record You Can Feel Good About
    • NC HealthConnex Participant Map
    • NC HealthConnex Participants
    • Patient FAQs
    • What You Need to Know
    • Your Choices
  • For Providers
    For Providers
    • About NC HealthConnex
    • Document Library
    • How to Connect
    • Participation Agreement
    • Training & Resources
    • Electronic Health Record Information
    • Electronic Health Record Vendor Connectivity Report
    • NC HIEA Data Disclosures
    • NC HIEA Policies
    • NC HealthConnex Participant Map
    • NC HealthConnex Participants
    • Patient Education Brochure Order Form
    • Privacy & Security
    • Provider Clinical Portal
  • Services
    Services
    • NC HealthConnex Exchange
    • NC*Notify
    • Controlled Substance Reporting System
    • Promoting Interoperability
    • Public Health Reporting
    • Direct Secure Messaging
    • Data Quality
    • Training
  • FAQs
    FAQs
    • General Background
    • Connection Deadline FAQs
    • Health Care Providers
    • House Bill 70
    • NC HealthConnex Data & Security
    • NC*Notify
    • Participation Agreement
  • About Us
    About Us
    • Contact Us
    • About the NC HIEA
    • What Does the Law Mandate?
    • Advisory Board
    • Mission, Vision & Guiding Principles
    • Strategic Roadmap
    • Work Groups
    • Staff & Partners
    • Technical & Application Support
  • News & Events
  • COVID-19
  • NC.GOV
  • AGENCIES
  • JOBS
  • SERVICES
NC HIEA »   For Providers »   Patient Education Brochure Order Form

Patient Education Brochure Order Form

Heath care providers can order trifold brochures to educate patients about the benefits of participating in NC Health Connex, the state health information exchange. The brochures also have information about patients' right to opt out of sharing their medical information.

See the patient education brochure.

Complete the following form to order brochures from the N.C. Health Information Exchange Authority. You can place an order to ship brochures to up to three different practice locations. Note that brochures come in packages of 100.

Indicates required field

Contact Information

Contact

Shipping

Shipping

Packages Requested

Each package contains 100 brochures. You must select one of the following options to submit the form.

English

Spanish

Would you like to order brochures for another practice?

Second Order

Contact Information

Contact (if different from above)

Shipping

Shipping

Packages Requested

Each package contains 100 brochures.

English

Spanish

Would you like to order brochures for another practice?

Third Order

Contact Information

Contact (if different from above)

Shipping

Shipping

Packages Requested

Each package contains 100 brochures.

English

Spanish

For Providers

  • About NC HealthConnex
  • Document Library
  • How to Connect
  • Participation Agreement
  • Training & Resources
  • Electronic Health Record Information
  • Electronic Health Record Vendor Connectivity Report
  • NC HIEA Data Disclosures
  • NC HIEA Policies
  • NC HealthConnex Participant Map
  • NC HealthConnex Participants
  • Patient Education Brochure Order Form
  • Privacy & Security
  • Provider Clinical Portal

Share this page:

  • Facebook
  • Twitter
  • Email

How can we make this page better for you?

Back to top

Contact

N.C.  Health Information Exchange Authority
Mail Service Center 4101
Raleigh, NC 27699-4101
(919) 754-6912
hiea@nc.gov

  • Translation Disclaimer
  • Accessibility
  • Terms of Use
  • Privacy Policy
  • Open Budget
NC HIEA
https://hiea.nc.gov/providers/patient-education-brochure-order-form