Chicago Police DepartmentSpecial Order S04-03-03
Release of Medical Information
Issue Date:18 June 1991Effective Date:19 June 1991
Index Category:Preliminary Investigations
This directive:
  • A.outlines procedures for obtaining medical information by Department members assigned to investigate police related incidents.
  • B.restricts the dissemination of medical information by the assigned investigator.
  • C.utilizes the term investigator to mean any member assigned to investigate an incident or allegation (e.g., detective, police agent, youth officer, police officer, Civilian Office of Police Accountability (COPA) investigator, etc.).
II.Medical Release Forms
  • A.To obtain medical information in police-related incidents, the assigned investigator will utilize:
    • 1.the Consent by Patient for Disclosure/Release of Medical Information form (CPD-44.117) for investigations conducted by the Civilian Office of Police Accountability (COPA); or
    • 2.the medical information release form which has been adopted by a particular hospital.
  • B.Information contained in a medical release form is confidential and restricted to:
    • 1.Department members assigned to conduct or required to review the investigation:
    • 2.members of the State's Attorneys Office when acting in their official capacity; or
    • 3.persons authorized by order of a court.
  • A.The assigned investigator will ensure that the appropriate medical release form is:
    • 1.properly completed.
    • 2.signed by the patient, or in the case of a minor, by the parent or guardian, or other authorized person.
    • 3.presented to the examining or treating physician.
  • B.When medical information has been obtained, the assigned investigator will:
    • 1.include a copy of the medical release form as part of the investigative case file.
    • 2.include copies of the medical release form in those related case files which require inclusion of the medical information for the purpose of completing the investigation.
  • C.When medical information is unavailable, the assigned investigator will include, as part of the investigative file, a Supplementary Report (CPD-11.411-A or B), a To-From-Subject Report, or a Detective Division General Progress Report (CPD-23.122), as appropriate, containing the following information:
    • 1.the name of the person(s) contacted in the process of requesting medical information:
    • 2.the reason(s) why the information was unavailable.
  • D.Law Enforcement Official's Request for Protected Health Information form (CPD-62.472)
    • 1.The Law Enforcement Official's Request for Protected Health Information form is being introduced for use throughout the Department. This form is to be used by any law enforcement official of the Department when requesting protected health information under the Health Insurance Portability and Accountability Act (HIPAA) from a medical facility and when a patient has refused consent or is otherwise unable to give consent for the release of medical information to the Department.
    • 2.The form will be distributed as follows:
      • a.Original (white) - Medical Facility
      • b.Yellow - Records Services Division
      • c.Pink - Unit of Requestor
    • 3.Members will continue to use the Consent by Patient to Disclosure of Information form (CPD-44.117), Consent by Patient to Release of Medical Information form (CPD-23.104), and the Hospital Run Sheet (CPD-62.420) when the patient consents to the release of medical information to the Department.
    • 4.The Law Enforcement Official's Request for Protected Health Information forms can be obtained from the  Equipment and Supply Section .
LeRoy Martin
Superintendent of Police
90-114 MU
Equipment and Supply Section
1869 W. Pershing 4th fl
PAX 4051