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Patients hold widely differing views and preferences on the exchange of their health data, and often in conflict with those of their care providers. The "Substance use HeAlth REcord Sharing" (SHARES) project at Arizona State University (ASU) is investigating those perspectives and their practical applications, using CDS Hooks to identify, label, and redact FHIR resources prior to their transmission across organizational boundaries, such as for care coordination and emergency care. Developed under NIH funding through 2028, all components are being developed as open source and open to collaboration with the FHIR community. This presentation acknowledges these varying perspectives and presents select practical challenges and approaches for finding middle ground in the messy, heavily charged area of patient privacy and consent using FHIR. For more information, see https://www.asushares.com.