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  • Il Cpd-62.372 2015

Get Il Cpd-62.372 2015-2026

HOSPITAL RELEASE Medical Section Human Resources Division Chicago Police Department Date: Hospital: Address: City/State/Zip: Officer 's Name: Social Security # Employee # Address: Date of Birth: Date.

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How to fill out the IL CPD-62.372 online

Filling out the IL CPD-62.372 form is a crucial step in the process of releasing medical information through the Chicago Police Department. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to fill out the IL CPD-62.372 form online

  1. Press the ‘Get Form’ button to access the IL CPD-62.372 document and open it for editing.
  2. Enter the date in the designated field at the top of the form, ensuring it is completed correctly.
  3. Fill in the hospital's name, address, city/state/zip in the provided sections to specify where the medical records are located.
  4. Input the officer's name and Social Security number accurately in the corresponding fields.
  5. Provide the employee number, address, and date of birth in the specified sections to ensure clarity regarding the individual in question.
  6. Document the date of treatment/admission in the appropriate field to establish when the medical care occurred.
  7. Indicate whether workman’s compensation is applicable by selecting the appropriate option, and provide details as necessary.
  8. Specify the medical records desired by checking the relevant items from the list provided, ensuring all essential records are requested.
  9. Include the case manager's attention note for proper routing of the records once submitted.
  10. Complete the member and witness signature sections, ensuring the dates are noted next to each signature for accuracy.
  11. Once completed, save the changes made to the document, then choose to download, print, or share the form as required.

Complete your IL CPD-62.372 form online today for efficient medical record processing.

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