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Get and Sign Connecticut Authorization Information

Get and Sign Connecticut Authorization Information

Use a Connecticut Authorization Information template to make your document workflow more streamlined.

Section 4 to: q (Fill out the name and address boxes) (Fill out the name and address boxes) Address 3. Information About: Name (Full name of Subject of Record) 4. Type Of Information: Date of birth (Check if authorization is for information concerning a minor child) Instructions: The person completing this authorization should be advised that this form may not be used to give both psychotherapy notes and other types of health information. If this form is being used to give psychotherapy...
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