NIOSH Safety and Health Topic:

World Trade Center Response

National Responder Program:

On May 31, 2008, CDC contracted with Logistics Health, Inc. (LHI) to manage the WTC National Responder Health Program to monitor and treat responders outside of the NYC-NJ metropolitan area. These responders were previously served by Mt. Sinai, the Association of Occupational and Environmental Clinics, and Federal Occupational Health Services. LHI is working with each of these organizations to transition the responders into the new structure. During this transition period, one goal of the National Program is to ensure that responders who have been receiving treatment are having their care continued without interruption.

If you were not or are not working for the FDNY and live outside the NYC vicinity, you should call LHI at 877-498-2911.

One part of the process for transferring into the National Program involves you requesting your prior medical records be sent to LHI. You can download, sign, and submit the appropriate form from the list below to expedite the transfer process.

Medical Records Release Form	Who Should Use This Form?	Instructions for Filling Out the Form
Mt. Sinai Clinical Centers Medical Records Release Form Clinical Center MSSM Release Form	This form should be used if you had treatment or were seen for a monitoring exam that was completed through one of the Mt. Sinai Consortium Clinics. Those clinics are: Mt. Sinai Medical Center Bellevue/New York University, Occupational &Environmental Medicine Clinic Queens College Center for the Biology of Natural Systems The State University of New York Stony Brook, Long Island Occupational Environmental Health Center University of Medicine and Dentistry of New Jersey, Environmental & Occupational Health Sciences Institute	Instructions for filling out the Mt. Sinai Clinical Centers Medical Records Release Form Clinical Center MSSM Instructions
Mt. Sinai Data and Coordination Center Medical Records Release Form DCC MSSM Release Form	This form should be used if you were seen for a monitoring exam that was completed through QTC or other provider that was coordinated by Mt. Sinai.	Instructions for filling out the Mt. Sinai Data and Coordination Center Medical Records Release Form DCC MSSM Instructions
AOEC Medical Records Release Form AOEC Medical Records Release Form	This form should be used if you had treatment or were seen for a monitoring exam that was coordinated through AOEC.	Instructions for filling out the AOEC Medical Records Release Form AOEC Release Form Instructions
Federal Workers Medical Records Release Form Federal Workers Medical Records Release Form	This form should be used if you received a monitoring exam through the program that was set-up by Federal Occupational Health.	Instructions for filling out the Federal Workers Medical Records Release Form Federal Workers Release Form instructions
Generic Medical Records Release Form Generic Medical Records Release Form	This form should be used if you had treatment or were seen for a monitoring exam that was completed through your primary healthcare physician.	Instructions for filling out the Generic Medical Records Release Form Generic Release Form Instructions

Mt. Sinai Coordinated Consortium Program

Page last updated: November 5, 2009
Page last reviewed: November 5, 2009
Content Source: National Institute for Occupational Safety and Health (NIOSH) Office of the Director

World Trade Center Response

The national response team assisting in New York City

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