When we examine, test, diagnose, treat, or refer you we will be collecting what the law calls Protected Healthcare Information (PHI) about you. We need to use this information here to decide on what treatment is best for you and to provide any treatment to you. We may also share this information with others who provide treatment to you or need it to arrange payment for your treatment or for other business or government functions.
At Connecticut Behavioral Health, LLC (CBH) we utilize an Electronic Health Record (EHR) system for note taking purposes. Our EHR system meets or exceeds all HIP AA and proposed HHS certification requirements, and monitors state and federal regulations to ensure your practice is always compliant. Additionally, the EHR features biometric security, data back-ups, redundant power supplies and continuous surveillance systems. All your data transfers with us have the highest level of SSL/TLS encryption against malicious parties. As this is a group practice, all CBH staffs client records are maintained under the same EHR. As CBH is an ethical practice we do not foresee any of our staff accessing a client's file that is not their own, however, we acknowledge that this is a possibility. A client's notes, once signed, cannot be adjusted by anyone in the practice.
By signing this form you are agreeing to let us use your information here and send it to others. The Notice of Privacy Practices explains in more detail your rights and how we can use and share your information. Please read this before you sign this Consent form.
If you do not sign this consent form agreeing to what is in our Notice of Privacy Practices we cannot treat you.
In the future we may change how we use and share your information and so may change our Notice of Privacy Practices. If we do change it, you can get a copy from our office, or by calling us at 203-271-1430 or from our Privacy Officer.
If you are concerned about some of your information, you have the right to ask us to not use or share some of your information for treatment, payment or administrative purposes. You will have to tell us what you want in writing. Although we will try to respect your wishes, we are not required to agree to these limitations. However, if we do agree, we promise to do as you asked.
After you have signed this consent, you have the right to revoke it (by writing a letter to our Privacy Officer telling us you no longer consent) and we will comply with your wishes about using or sharing your information from that time on but we may already have used or shared some of your information and cannot change that.