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.

FAQ

Q: What is Form CN4401/1?
A: Form CN4401/1 is the Authorization to Obtain and/or Disclose Protected Health Information specific to Connecticut.

Q: What is the purpose of Form CN4401/1?
A: The purpose of Form CN4401/1 is to give consent and authorization for the release of protected health information in Connecticut.

Q: Who should use Form CN4401/1?
A: Form CN4401/1 should be used by individuals who want to authorize the disclosure of their protected health information in Connecticut.

Q: What information is required on Form CN4401/1?
A: Form CN4401/1 requires the individual's name, contact information, the information to be disclosed, the purpose of the disclosure, and the recipient of the information.

Q: Is Form CN4401/1 mandatory?
A: No, Form CN4401/1 is not mandatory. It is optional and voluntary.

Q: How long is Form CN4401/1 valid?
A: The validity of Form CN4401/1 depends on the specified expiration date or event mentioned on the form.