Medical Records

The confidentiality of this record is required under Chapter 899 P.L. 93-579 of the Connecticut General Statutes as well as Title 42 of the United States Code. This material should not be transmitted to anyone without the client’s written consent or authorization as provided for in these Statutes

• • I understand that the medical record to be released may contain information pertaining to psychiatric, drug, and/or alcohol abuse diagnosis and treatment, and may also contain confidential HIV (AIDS) related information. A general authorization for the release of medical or other information is NOT sufficient for this purpose.
• • I understand that under applicable law the information disclosed under this authorization may be subject to further disclosure by the client and thus may no longer be protected by federal privacy regulations.
• • I understand that I may inspect or copy the information to be used or disclosed.
• • I understand that my current treatment or continued treatment by Stonington Institute is in no way conditioned on whether or not I sign this authorization and that I may refuse to sign it.
• • Any information protected by Federal Regulations governing confidentiality of alcohol and drug abuse patient records (42CFR, Part 2) is prohibited from further disclosure by the recipient without specific authorization for such re-disclosure.
• • ONLY the actual client can complete releases of information for themselves unless you are an authorized representative with provided documentation.