UConn Health Center - HIPAA Opt-Out

The privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) apply to health information created or maintained by health care providers who engage in certain electronic transactions, health plans and health care clearinghouses. HIPAA governs how health care providers like the UConn Health Center handle patient information. HIPAA permits the UConn Health Center and its institutionally related foundation, The University of Connecticut Foundation, Inc., to use certain information (name, address, telephone number, dates of service, age and gender) to contact you in the future to raise funds for the benefit of the UConn Health Center, provided that patients are given the opportunity to "opt-out" of such fundraising communications.

If you are a current or former patient of the UConn Health Center and you wish to have your name removed from future fundraising communications supporting the UConn Health Center, please call the Foundation between 8:30 AM and 5:00 PM, Monday-Friday at 800.269.9965. You may also complete the form below.

Patient privacy opt-out is only for past and current patients of the UConn Health Center.

After you contact us with this request, reasonable efforts will be made to ensure that you do not receive any communication from us in the future that you do not authorize.

First Name
Middle Initial
Last Name
Date of Birth
Date of Most Recent Treatment
Mailing Address
Home Phone
Preferred Phone
Email Address
Do you wish to receive
any informational mailings
from the UConn Foundation? 		   Yes    No 
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