Health Information Authorization Form

Health Information Authorization Form

Waterbury Hospital is in compliance with Connecticut Statute Title 20 §20-7c(b)

Upon a written request of a patient, his attorney or authorized representative, or pursuant to a written authorization, a provider, except as provided in section 4-194, shall furnish to the person making such request a copy of the patient’s health record.

No provider shall charge more than Sixty-five cents per page, including any research fees, handling fees or related costs, and the cost of first class postage, if applicable.

A provider shall furnish a health record requested pursuant to this section within thirty days of the request.