ACCOUNTING OF DISCLOSURES OF RECORDS MADE TO PERSONS OR ENTITIES OUTSIDE THE CENTRAL INTELLIGENCE AGENCY

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP84B00890R000600140014-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 16, 2016
• Document Release Date: July 21, 2005
• Sequence Number: 14
• Publication Date: June 5, 1981
• Content Type: FORM

' ROUTING AND RECORD SHEET
suB~ecT: (optional) Accounting of Disclosures of Records Made To Persons
Or Entities Outside The Central Intelligence Agency
FROM:
Executive Officer,
EXTENSION
NO.
OGC 81-04296 DD/A Registry
Office of Medical Services
Room 1D4061 Headquarters
DATE
5 June 1981
8l-~13 ~ ~
TO: (Officer desi
nation
room number
d
g
,
, an
building)
DATE
OFFICER'S
COMMENTS (Number each comment to show from whom
RECEIVED
FORWARDED
INITIALS
M whom. Draw a line across column after each comment.)
1?Executive Officer, DD
Room 7D-18 Headquarte
s
2.
3.
4.
5.
b.
7.
S.
9.
10.
11.
12.
13.
14.
15.
FORM ~~ O USE PREVIOUS
I-79 EDITIONS
~;, y Approved For lease 2005/08/02 :CIA-RDP84B0089
Approved For Release 2005/08/02 :CIA-RDP84B00890R000600140014-4
 Approved For~ease 2005/08/02: CIA-RDP84B0089~00600140014-4
Accounting of Disclosures of Records Made
To Persons Or Entities Outside
The Central Intelligence Agency
The Office of Medical Services releases medical
records of current employees, former employees, and
unsuccessful applicants to designated physicians, health
insurance companies, schools, and government agencies
upon official request. Each request is checked and
verified for authenticity and must identify the medical
facility and address to which the records are to be sent,
the specific records to be forwarded, date, printed
name and signature of the authorizer, as well as his/her
telephone number and date of birth. The specific medical
documents are copies and sanitized in order to protect
Office of Medical Services and Agency equities.
Appropriate cover protocol is followed if indicated.
'the xequest and final action becomes part of the
subject's Office of Medical Ser~rices medical file, and
the date the records sent is duly recorded.
STA
Ex c ive Officer
Office o Medical Services
Approved For Release 2005/08/02: CIA-RDP84B00890R000600140014-4