A copy of the patient's and/or signee 's government-issued identification must accompany this request. If applicable, proof of appointment of Power of Attorney or Conservator must be submitted.
NOTE TO RECIPIENT OF INFORMATION:
Confidentiality of psychiatric, drug and/or alcohol abuse, and HIV/AIDS related records is required and no information from these specific records shall be transmitted to anyone else without written consent or authorization as provided under Connecticut General Statutes Chapters 899 and 368x and Federal Regulations 42 CFR 2. These laws prohibit you from making any further disclosure without specific written consent of the person to whom it pertains. A general authorization for the release of information is NOT sufficient for this purpose.