Protect Your Medical Information!

To Any and All Medical/Health Care Providers,

I hereby prohibit you from providing any medical and/or personal information about me and my family in any format to any entity not directly involved in participating in our medical care for a specific issue or to my personal medical insurance company.  No such information may be placed on and/or made available through the internet to anyone or any entity except those above.  No such information shall be made available to any entity of the State of (State) or the United States Federal Government.  Information shall not be made available even if stripped of any personally identifying information.  Any information in electronic format must be stored only on your local premise and computers.  It may not be stored or managed offsite and/or by another entity.