ICE USE ONLY EFTA00283630 tlf/ZbiZU I 4 U4:1 tam hbhi #149 Page 06/06 • • " .4.-a• •F • ....ord. rr - %se .es..-••••-•••••nui ' .MOUNT,SINAI HEALTH INFORMATION EXCHANGE AND HEALTHIX CONSENT FORM The Mount Sinai Health irrformation Exchange ('Mount Sinai HIE') and Health& sham Information start