CT Hartford HealthCare 571559 2017 free printable template
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9038 Windham Health Information Management 112 Mansfield Avenue Willimantic CT 06226 Fax 860. 456. 7605 Natchaug Health Information Management 189 Storrs Road Mansfield Center CT 06250 - Fax 860. 456. That I may refuse to sign it. Authorization can be sent to Backus Health Information Management 326 Washington Street Norwich CT 06360 - Fax 860. 1381 Rushford Health Information Management 1250 Silver Street Middletown CT 06457 - Fax 860. 346. 224. 5920 MidState Health Information...
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Obtain the CT Hartford HealthCare 571559 form from the official website or contact their office for a physical copy.
02
Read the instructions provided with the form carefully to understand the requirements.
03
Fill in your personal information in the designated sections, including your name, address, and contact information.
04
Provide any necessary medical information requested, such as health history or insurance details.
05
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Who needs CT Hartford HealthCare 571559?
01
Individuals seeking medical services from CT Hartford HealthCare.
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Patients requiring insurance claims to be processed.
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Anyone needing to update their health information with CT Hartford HealthCare.
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People Also Ask about
What is the employer identification number for Hartford HealthCare?
Charity Navigator currently only has one year of consecutive e-filed Forms 990 from the IRS for Hartford Healthcare Medical Group Specialists Pllc under the EIN: 37-1911194.
What is an authorization to use and disclose protected health information?
A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.
Is Hartford Hospital Level 1?
Our center is verified by the American College of Surgeons (ACS) is one of three Level I Trauma Centers in Connecticut.
What level of trauma is Hartford Hospital?
Hartford Hospital is the region's first Level 1 Trauma Center, and operate the state's first air ambulance system, LIFE STAR.
How do I contact Hartford HealthCare?
Contact Us 1.855.HHC.HERE (1.855.442.4373) Hartford HealthCare Administrative Offices: 860.263.4100.
What is required for an authorization to disclose PHI?
The core elements of a valid authorization include: A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.
What is an example of when authorization is needed for use and disclosure of PHI?
When Must Patient Authorization be Obtained for Uses and Disclosures of PHI? Authorizations are generally required for psychotherapy notes, substance abuse disorder and treatment records, and for marketing purposes.
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What is CT Hartford HealthCare 571559?
CT Hartford HealthCare 571559 is a specific form or document used for filing purposes related to healthcare services in Connecticut.
Who is required to file CT Hartford HealthCare 571559?
Entities such as healthcare providers, organizations affiliated with Hartford HealthCare, or those who offer services that fall under Connecticut's healthcare regulations may be required to file CT Hartford HealthCare 571559.
How to fill out CT Hartford HealthCare 571559?
To fill out CT Hartford HealthCare 571559, you need to provide relevant healthcare service details, financial information, and any specific data requested on the form according to the guidelines provided.
What is the purpose of CT Hartford HealthCare 571559?
The purpose of CT Hartford HealthCare 571559 is to collect and report information regarding healthcare services, compliance, and financial activities of healthcare entities in the state.
What information must be reported on CT Hartford HealthCare 571559?
Information required on CT Hartford HealthCare 571559 typically includes service provider details, patient care statistics, financial disclosures, and compliance data as necessary for state health authorities.
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