Consent and Conditions of Treatment Form

February 20, 2024

The UConn Health Consent and Conditions of Treatment Form (HCH 901), formally known as the Consent to Treat Form, has been updated and will roll out on March 1, 2024, across the institution.

The Consent and Conditions of Treatment form documents consent for reasonable and necessary healthcare services, acknowledgement of receipt of the Notice of Privacy Practices, authorization for release of information for payment purposes, and assignment of benefits for services provided to patient and paid on their behalf. Additionally, the updated form addresses methods of contact, advance directives, and personal valuables/personal property.

For additional information, please contact the OHCP at ohcp@uchc.edu or 860-679-6060.