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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

6-30-2014

Subchapter:

1

Forms

Issuance:

21.40

CP&P Form 21-40, Medical Request Letter

 

Click here to view or print the CP&P Form 21-40, Medical Request Letter.

 

PURPOSE AND USE:

 

CP&P Form 21-40, Medical Request Letter, is a letter written by the Director of Clinical Services for the Department of Children and Families explaining the CP&P Form 21-7, Request for Information Pursuant to N.J.S.A. 9:6-8.40. This form is used to accompany the CP&P Form 21-7, Request for Information Pursuant to N.J.S.A. 9:6-8.40. The letter is used to request access to all medical records and other important clinical information that is needed to provide proper care to children involved with the Division of Child Protection and Permanency. The letter also explains the provision made under the law that allows CP&P access to such information.

 

INSTRUCTIONS:

 

  1. Type in the date under the letterhead.
  2. Print the CP&P Form 21-40 on official office letterhead.
  3. Attach the CP&P Form 21-40 to the CP&P Form 21-7, Request for Information Pursuant to N.J.S.A. 9:6-8.40.

 

DISTRIBUTION:

 

Original          -           Agency and/or practitioner from whom medical

                                    or clinical information is being sought

Copy               -           Child's case record