Form CN4401 / 1 Authorization to Obtain and / or Disclose Protected Health Information - Connecticut

What Is Form CN4401/1?

This is a legal form that was released by the Connecticut State Department of Correction - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on November 17, 2022;
• The latest edition provided by the Connecticut State Department of Correction;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a printable version of Form CN4401/1 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Correction.