Order For Release Of Medical Records {CCJP 0674}

CCJP 0674 - ORDER FOR RELEASE OF MEDICAL RECORDS. This form is used in child protection proceedings within the Circuit Court of Cook County, Illinois. This form authorizes a specified medical provider or facility to release any and all medical records related to a minor, including toxicology reports, treatment notes, counseling records, discharge summaries, photographs, x-rays, and other documented evidence. The release is governed by several federal and state confidentiality laws, including HIPAA, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, and the Alcoholism and Other Drug Abuse and Dependency Act. The records are sought solely for use in pending Juvenile Court proceedings involving allegations of abuse, neglect, or dependency, and are limited to the parties involved in the case who have a legitimate need for the information. Because Juvenile Court proceedings are confidential, further disclosure is strictly limited. This order is granted based on a showing of good cause and necessity, with the court finding that the need for disclosure outweighs any potential harm to the patient’s privacy or the physician-patient relationship. The order expires upon the conclusion of the juvenile court case or on a specified date, whichever occurs first. www.FormsWorkflow.com