Please complete this form if you do not want to share your clinical data in Connie, the Connecticut statewide health information exchange.

What is a Health Information Exchange?

A Health Information Exchange (HIE) is a secure electronic way for health care providers and organizations to share clinical information about their patients. In Connecticut, the state-wide HIE is called Connie.

Why do health care providers have to share clinical information?

When you need to receive care, it is critical that your health care provider has the most recent information about your health. Your provider can search the HIE for your health information to reference while providing your care.

What if I don’t want to share my clinical information through Connie?

You may follow the directions below to opt out of sharing clinical information through Connie.

What happens once I send in my opt-out form?

Your health information will be deleted from Connie within 5 business days. Once your data is deleted, your provider will not be able to search Connie for your health information. However, some providers will use Connie to send information about their patients to each other directly. This is the same as when providers share information by fax or by mail.

If a provider searched Connie for your information and put that information into their medical records before you completed your opt-out, that information will remain in that provider’s medical records.

What if I change my mind and want to share my clinical information?

We are happy to help, please call us at (866) 987-5514 so that we can make that change for you.

Unfortunately, we cannot retrieve the information we deleted when you opted out so your historical clinical information will not be in Connie.

Are there exceptions to my choice to opt-out?

Yes. Public health reporting, such as the reporting of infectious diseases to public health officials, will still occur through the HIE after you decide to opt out. Also, Controlled Dangerous Substances (CDS) information, as part of the Connecticut Prescription Drug Monitoring Program, will continue to be available through the HIE to licensed providers.

Do I have to fill this form out every year?

No, you only need to fill it out once for yourself. You do not need to fill this out for each provider you have. We will keep this information and your decision in place until you decide to opt back in.

If you don’t live in Connecticut but you see a provider in Connecticut, you should complete this form to opt out.

Connie Opt-Out Form

You have several options for sending this form to Connie:

**You must be 13 years or older to fill out this form.**
1.Fill out the form below and click Submit.(preferred)
2.Fill out this form and fax your completed form to 443.817.9587
3.Fill out this form and email your completed form to
4.Fill out this form and mail it to: Connie, 400 Farmington Avenue, Farmington, CT 06032
5.Call 866-987-5514

If you wish to reverse your decision, you may opt back in at any time by calling Connie at 866-987-5514.

Patient Opt-Out Form