Privacy Practices

Important: Notice of Privacy Practices

Chrysalis Center, Inc.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

It is important to read and understand this Notice of Privacy Practices before signing the Consent and Acknowledgment Form.

Any Questions?

If you have any questions about this Notice or would like further information concerning your privacy rights, please contact :

Privacy Officer:
255 Homestead Avenue
Hartford, CT 06132
(860) 263-4400

Notice of Privacy Practices

Effective Date: April 14, 2003

This Notice of Privacy Practices (the “Notice”) is meant to inform you of the uses and disclosures of protected health information that we may make. It also describes your rights to access and control your protected health information and certain obligations we have regarding the use and disclosure of your protected health information.

Your “protected health information” is information about you created and received by us, including demographic information, that may reasonably identify you and that relates to your past, present or future physical or mental health or condition, or payment for the provision of your health care.

We are required by law to maintain the privacy of your protected health information. We are also required by law to provide you with notice of our legal duties and privacy practices with respect to your protected health information and to abide by the terms of the Notice that is currently in effect. However, we may change our notice at any time. The new revised Notice will apply to all of your protected health information maintained by us. You will not automatically receive a revised Notice. If you would like to receive a copy of any revised Notice you should ask at your next appointment.