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How to Edit and draw up City of cleveland ems medical authorization Online. Other requirements vary depending upon the institution providing the paramedic program. On June 30, 2021, Houston City Council voted to . Prior to its formation, police cars were used for emergency hospital transportation. 0000003145 00000 n
Illinois submits EMS data to the National Emergency Medical Services Information System (NEMSIS) national data repository on a quarterly basis. I, ,(APPLICANT'S NAME) do hereby authorize a review of, and full disclosure of all records or any part thereof, concerning myself by and to a duly authorized agent of The Easton Volunteer Emergency Medical Service, Inc., whether said records are of a public, private, or confidential nature. The tax rate will effectively be raised by 1.68 percent and will raise taxes for maintenance and operations on a $100,000 home by approximately $5.80. city of chicago ems 33589 treasury center city of chicago ems 33589 treasury center. Bentonville Parks & Recreation is pleased to announce the reopening of Applegate Trail. th)Hf R$jOH}Il*@^UNk2-5\jxJW{j8Q7|I;*9:I?pRHkA/
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Sign the form and send it to the address below (the one of your visit): Medical Records. With over 20 years working in public service for the City of Philadelphia, serving in the Department of Records, Department of Human Services, Health Department, and the School District of Philadelphia, she is passionate about ensuring that children and adults have access to high-quality health care, education and . Seamlessly orchestrate process-centric best pra Competently leverage others high standar Appropriately pontificate synergistic para digm Seamlessly syndicate out-of-the-box quality vec why did the ethiopian government fall in 1991, Lancaster Performing Arts Center Capacity, dynamically add rows to table react native, what happens when you finish all classes in bully, rectangular bathroom mirror with rounded corners, project for primary classroom the tropical rainforest, greenery garland near rome, metropolitan city of rome, city of chicago ems records authorization. For patient bills, call 844-353-7842. 0000003234 00000 n
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Street Address: City, State, ZIP Code: Phone number: Claim or policy number: CITY OF CHICAGO DEPARTMENT OF FINANCE -EMS 333 S. STATE ST. ROOM 400 CHICAGO, IL 60604-3978 (312) 745-7329 AUTHORIZATION FOR RELEASE OF INFORMATION OF AMBULANCE CHARGES For the Use and Disclosure of Protected Health Information Cleveland's Emergency Medical Service (EMS) Division was one of the country's first. Authorization. . Emergency Medical Services Government Mayor Jim Strickland City Court Clerk Finance Law Public Works City Council Communications Fire Department Libraries 311 Boards and Commissions Data-Driven Memphis General Services Memphis 3.0 Contact Us Solid Waste Management Engineering Division of Housing & Community Development 2120.1010 Authorization to Repair Boilers and Pressure Vessels 2120.1020 Issuance and Renewal of the Certificate 2120.1030 Changes to Certificates of Authorization 2120.1040 Quality Control Requirements 2120.1041 Repair and Alteration Requirements SUBPART D: STATE SPECIALS Section The mission of the National Registry of Emergency Medical Technicians has always been centered on protecting the public and advancing the EMS profession. HWk0
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([)Tv}xCzi Patients or authorized representatives requesting copies of medical records and/or an itemized billing statement must submit a completed Authorization For Release of Protected Health Information form, all required supporting documentation, and payment for any fees owed, to the EMS Records Unit via e-mail to LAFD.EMSRecords@lacity.org, or by regular mail to LAFD at the address listed on the form. A reasonable, cost-based fee may be charged for permitted costs of providing the record. Stop Struggling - Start ChartSwapping. Welcome to . Read the following instructions to use CocoDoc to start editing and writing your City of cleveland ems medical authorization: To start with, look for the "Get Form" button and tap it. Medical records for current or former Chicago Department of Public Health patients can be requested by email to CDPHCompliance@cityofchicago.org, via fax to (312) 747-9663, by phone to (312) 747-9672 , or in person at any of our clinic sites. 0000002737 00000 n
Records Deposition Service (833) HIRE-RDS | (833) 447-3737 Records Deposition Service Client Portal Home About Services Authorizations Request a Record Testimonials Contact Download hundreds of facility-specific authorizations right here, right now. Exact location Date of fire incident How you would like the information sent (via email, fax or mail) For Fire FOIA requests, write to: Email: CFDFOIA@cityofchicago.org Fax: 312.745.3900 Mail: Freedom of Information Officer Chicago Fire Department 3510 S. Michigan Avenue Chicago, Illinois 60653 Please note that all FOIA requests are posted online. Soon, you'll be able to make all of your payments here - whether you are paying your water bill or your parking ticket.
We are committed to improving the quality of life in the City of Cleveland by maintaining . FOIA Request Log - Fire. Please click on links below to access individual EMS Policies: Field to Hospital Communication EMS Report Format, Advanced DirectivesCall DispositionConsent & Refusal of ServiceConveyance of PatientsCrime Scene ResponseDetermination of Death / Withholding of Resuscitative MeasuresEMS StaffingEpinephrine Dilution For ShortageGuidelines for Preventing Disease TransmissionInitiation of Patient CareLarge Gatherings & Special EventsManagement of Multiple Patient Incidents Medication Administration Cross Check (MACC)Physician or Nurse on SceneReporting Abused or Neglected PatientsRestraintsSchool IncidentsTermination of ResuscitationUse of Controlled Substances, Patient Transport Private Ambulance ProviderPatient Transport Chicago Fire DepartmentPediatric Patient TransportTrauma Patient Triage and TransportTransport of Patients with Suspected Acute StrokeTransport of Patients to a STEMI CenterTransport of Cardiac Arrest PatientsObstetrical Patient Transport Transport of Patients with a Ventricular Assist Device (VAD)Transport of Veteran Patients to Veterans Affairs Medical CentersSuspected COVID-19 Patient Triage and Transport Transport of Patients with Suspected Ebola Virus Disease (EVD)Helicopter EMS Utilization (HEMS)Critical AirwayInterhospital and Interfacility TransferNotification and Monitoring of Hospital Resource Limitation & Ambulance BypassResponse to a System-Wide Crisis within the Chicago EMS System, Documentation RequirementsEMS System Inventory Inspection PolicyConfidentiality of Patient Records, Continuing Education Testing EMS Lead InstructorIDPH EMS Continuing Education Relincensure Recommendations Out-of-System Continuing Education, System EntryEMS Personnel Reregistration & Relicensing RequirementsEMS Personnel ReinstatementSupervised Field Internship with the Chicago Fire DepartmentEMS PreceptorPrehospital R.N.Community ParamedicFitness for DutyInactive StatusSuspensionSystem Review BoardVaccine Administration, Base Station Cardiac Arrest GuidelinesECRN and Physician BackupParticipating Hospital ResponsibilitiesRecognition, Rerecognition and Suspension of ECRNs and ECPsResource Hospital Base Station Override, IDPH Waiver ProvisionRequest for Clarification (RFC)Medical Device ReportingProtocol for Resolving Regional or Inter-System ConflictEMS System Quality Improvement & Assurance Program, Region 11 EMS Medical Directors Consortium Memos, Mobile Integrated Healthcare Community Paramedic (MIH-CP), Determination of Death / Withholding of Resuscitative Measures, Guidelines for Preventing Disease Transmission, Medication Administration Cross Check (MACC), Patient Transport Private Ambulance Provider, Patient Transport Chicago Fire Department, Transport of Patients with Suspected Acute Stroke, Transport of Patients with a Ventricular Assist Device (VAD), Transport of Veteran Patients to Veterans Affairs Medical Centers, Suspected COVID-19 Patient Triage and Transport, Transport of Patients with Suspected Ebola Virus Disease (EVD), Notification and Monitoring of Hospital Resource Limitation & Ambulance Bypass, Response to a System-Wide Crisis within the Chicago EMS System, IDPH EMS Continuing Education Relincensure Recommendations, EMS Personnel Reregistration & Relicensing Requirements, Supervised Field Internship with the Chicago Fire Department, Recognition, Rerecognition and Suspension of ECRNs and ECPs, Protocol for Resolving Regional or Inter-System Conflict, EMS System Quality Improvement & Assurance Program. A quick and secure way to pay your EMS bills and more. This is the second year in a row the tax rate has been lowered. FOIA Documents Maintained by Departments. These Region 11 Chicago EMS System Protocols, Policies, and Procedures for EMTs and Paramedics are prehospital medical guidelines for patient assessment, treatment, and transportation within the system. CONTACT INFO. Emergency Medical Services (EMS) responds by assessing, treating, stabilizing, and transporting patients until definitive medical care is available at an appropriate facility. Have a copy of your invoice ready with the invoice number. 3) $20.00 for a report generated by an accident reconstruction officer or city of chicago ems records authorization. P: 216.664.2555 F: 216.420.8373 TTY: 800.750.0750 Emergency Medical Services (EMS) is an exciting field within public safety which allows people to provide pre-hospital emergency medical care to ill or injured patients, frequently on ambulances. Please provide your account number and ZIP code to continue. EFFECTIVE: This authorization request does not apply to any treatment dates beyond the date of signature. All data represent hospital status as of 11:59 pm for that calendar day. 0000024531 00000 n
Request Medical Records Online. World Star New Super Mario Bros 2, Austin 3-1-1. Find Plans By City; Health Insurance Insights; Healthcare Research; Healthcare Glossary ; X. Finance. Tax page on nola.gov; Property assessment lookup . HW[oF~G?]-/UJ6YU8Y s\lOMss9/u{t-{&zZ|Nut=_-e\LO&/'9VQ3E&vW\_vk (QgR5XechU5jE}Cg8Ph*+Eam5j*P15e!:I8gy%"UT%r9P/aI2td$u$#pYz*7 Instructions . 0000000016 00000 n
Tracey T. Williams is the Deputy Commissioner for the Department of Records. If you are covered by medical insurance, Medicare, Medicaid or are a member of an HMO, please provide information about your coverage on the back of the ambulance bill, sign the bill, and return it to our office. Open to active CFD Paramedics and EMTs ONLY 3 hours of continuing education available. EMTs are trained to assess vital signs (blood pressure, heart rate, and breathing), provide CPR, operate an automated external defibrillator (AED), deliver oxygen to patients, bandage wounds, splint injured limbs, and assess a patients medical condition through a series of questions. Last year was lowered for the first time in 16 years. AUTHORIZATION FORMS (PDF Format) Academic Records By facsimile to (312) 745-6948. city of chicago ems records authorization. Cleveland's Emergency Medical Service (EMS) Division was one of the country's first. Typical requirements to enroll in an EMT program include: Other requirements vary depending upon the institution providing the EMT program. A federal grant enabled the City to purchase a dozen ambulances and train 120 Emergency Medical Technicians (EMT's). South Lake Tahoe. endstream
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EMS Training Division . Chicago Central EMS System (#1108) Patti Lindeman, MBA, RN Office: (312) 926-5393 Email: plindema@nm.org. Sign the form and send it to the address below (the one of your visit): Medical Records. The Houston Fire Department is guided by the Houston Health Department, Houston Local Health Authority and the Centers for Disease Control and Prevention (CDC) regarding best practices for protecting our firefighters and preventing the spread of the virus. CITY OF CHICAGO DEPARTMENT OF REVENUE P.O. TO OBTAIN PUBLIC RECORD PER CITY ORDINANCE S-36997 JULY 1, 2010: Submit a written request form via fax, e-mail, in person, or by postal mail. 0000085323 00000 n
Easy access to COVID-19 vaccines is equally important. %%EOF
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CITY OF CHICAGO DEPARTMENT OF REVENUE P.O. HOME-American Rescue Plan. Step 4: Select Either "Fire Request" or "Emergency Medical Services (EMS) Request. IDPH Administrative Code on EMT Licensure, Frequently Asked Questions Transition to National Registry Testing, IDPH Administrative Code on License Renewals, IDPH Change of Address & License Renewal Brochure, Region 11 EMS Medical Directors Consortium Memos, Mobile Integrated Healthcare Community Paramedic (MIH-CP). Account Number: ZIP Code: A safe and effective COVID-19 vaccine is a critical component of the U.S. strategy to reduce COVID-19-related illnesses, hospitalizations, and deaths. Accurate Biometrics is the contracted live scan vendor for the Chicago Public School system, for State of Illinois and FBI fingerprint-based background checks. C.33 to C.35 D. DOCUMENTATION Documentation Requirements. 0000024908 00000 n
All EMS billing questions should be directed to Change Healthcare, (833) 812-0564 . Registration required, Region 11 EMS Medical Directors Consortium Memos, Mobile Integrated Healthcare Community Paramedic (MIH-CP). Tracey T. Williams is the Deputy Commissioner for the Department of Records. Freedom of Information Section, Unit 114. Any and all records including mental health, HIV/AIDS (inc luding testing, diagnosis and treatment), genetic testing and/or substance abuse records. City of Rosenberg 2110 4th Street P.O. Report a power outage. EMT and Paramedic Information. Emergency Medical Services (EMS) is an exciting field within public safety which allows people to provide pre-hospital emergency medical care to ill or injured patients, frequently on ambulances. They provide a framework for all patient encounters and Online Medical Control should be consulted in situations where there is not clear direction from the written documents. This page posts Fire/EMS calls and other events in Green County Wisconsin. How to Edit and draw up City of cleveland ems medical authorization Online. Number of Views 584. da tower bridge development landmark place / marted, 02 Novembre 2021 / Pubblicato il satori capital fund size . 0000024389 00000 n
Chicago fire department records authorization keyword after analyzing the system lists the list of keywords related and the list of websites with related content, in addition you can see which keywords most interested customers on the this website The information on this website is taken from records made available by state and local law enforcement departments, courts, city and town halls, and other public and private sources. If your looking for Automobile And Other Motor Vehicle Merchant Wholesalers in Chicago, Illinois - check out City Of Chicago Ems. An official website of the City of Chicago, Permit for Business ID and Advertising Signs, Vital Records from the Cook County Clerk's Office, AIC (Annual Inspection Certification) Inspections, Economic Disclosure, Affidavit, Online EDS, City Council Office of Financial Analysis, Community Commission for Public Safety & Accountability, City of Chicago's Notice of Privacy Practices. 4993. undercover office potty writer; monkey ace best path btd6. make business checks or money order payable to "city of . In the event the City of Portland Fire Department may receive Columbus, Ohio 43207 Office: 614.221.3132 . Sign the form and send it to the address below (the one of your visit): Medical Records. Brooklyn, NY 11201. 0000010301 00000 n
City-County Building Lighting - What Do Tonight's Colors Represent? Phone: 850-837-4242. city of chicago ems records authorization. New Fire Station 4 at 81 West Thornton Street, Akron Ohio 44311. Providers are able to charge an administration fee for the vaccine. THE CITY OF KILLEEN ADOPTED A TAX RATE THAT WILL RAISE MORE TAXES FOR MAINTENANCE AND OPERATIONS THAN LAST YEAR'S TAX RATE. Vaccines protect you and the people around you, reducing the spread of COVID-19. startxref
You may choose to provide an event (related to you or the purpose of the use/disclosure) upon which your authorization will expire, unless mental health records are requested. Number of Views 453. . xb```b``]AXcC(`PHGO=k ;j CjP X0a 155 0 obj
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CITY OF CHICAGO DEPARTMENT OF FINANCE - EMS 333 S. STATE ST. ROOM 400 CHICAGO, IL 60604-3978 (312) 745-7329 AUTHORIZATION FOR RELEASE OF INFORMATION OF AMBULANCE CHARGES For the Use and Disclosure of Protected Health Information Name of attorney or alleged liable party: Street Address: City, State, ZIP Code: Phone number: Claim or policy number: Box 32 Rosenberg, TX 77471 Phone: 832-595-3300 Email; Quick Links. All Chicago area (EMS Region XI) hospitals (n=27) are required to report bed and ventilator capacity, availability, and occupancy to the Chicago Department of Public Health (CDPH) daily. AUTHORIZATION . Emergency Medical Services (EMS) is an exciting field within public safety which allows people to provide pre-hospital emergency medical care to ill or injured patients, frequently on ambulances. Within EMS Region 11, there are four separate EMS Systems under the medical control of four hospitals: Advocate Illinois Masonic Medical Center, Northwestern Memorial Hospital, The University of Chicago Medical Center, and John H. Stroger Jr. Hospital of Cook County. Property Tax Rates in the City of Rosenberg: This notice concerns the 2021 property tax rates for the City of Rosenberg. Fill out the whole form including the kind of records and dates of your visits. M*Z=r1pP.*._zJ{
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All ambulances that operate in the City of Houston will be required to meet the new equipment requirements. On 02/09/2021 Marshall filed an Other court case against City of Chicago EMS in U.S. Bankruptcy Courts. Phone: 773-702-1637. Additional informationregardingambulance reports or bills may be found here: Ambulance Bills, An official website of the City of Chicago, City Council Office of Financial Analysis, Community Commission for Public Safety & Accountability, General Inquiries: healthychicago@cityofchicago.org, Media Inquiries: media.cdph@cityofchicago.org, FOIA Requests: CDPHFOIA@cityofchicago.org, Mar 3, 2023 - City of Chicago Announces New Initiatives to Combat the Opioid Epidemic Using Funds from Settlements with Pharmaceutical Companies, Mar 2, 2023 - Chicago Department of Public Health Weekly Media Brief, Feb 8, 2023 - City to Host Final COVID-19/Flu Family Vaccination Clinic of Season at Truman College on Saturday, Feb 3, 2023 - CDPH COVID-19 Update: Cook County and Chicago Remain in Low COVID-19 Community Level, Jan 30, 2023 - City of Chicago Announces Expansion of Alternative 911 Response Program, How to Obtain a Chicago Department of Public Health Medical Record. EMS Policies These Region 11 Chicago EMS System Protocols, Policies, and Procedures for EMTs and Paramedics are prehospital medical guidelines for patient assessment, treatment, and transportation within the system. The EMS works under the direction of the Fire Chief and the Assistant Operations Chief, while working closely with the Medical Director, to design and train for operations programs which comply with legal mandates, health issues, and minimization of legal liabilities. Get information on the doctor and which Health Insurance Plans are accepted. Telephone and walk-in reception for the department. Scritto il 15 Febbraio 2022. . We get it done fast. Learn more atLearn more at Chicago.gov/COVIDVax. Cleveland's Emergency Medical Service (EMS) Division was one of the country's first. The South Side neighborhood contains this property. Limitation(s)/Ambulance Bypass. Read the following instructions to use CocoDoc to start editing and writing your City of cleveland ems medical authorization: To start with, look for the "Get Form" button and tap it. All Chicago area (EMS Region XI) hospitals (n=27) are required to report bed and ventilator capacity, availability, and occupancy to the Chicago Department of Public Health (CDPH) daily. University of Chicago Medicine. Authorization Form for Release of Protected Health Information Form. Medical Records Dept. Planning and Development. Water & Sewer Issues 405-321-1600. Careers. This level of licensure is the entry level into the exciting field of EMS. endstream
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Latitude and longitude for the address: 41.700542,-87.710559. An indigenous credible investment platform for Ife people . COUNTY OF HANCOCK HANCOCK COUNTY EMS: Organization: 2007 E US HIGHWAY 136 CARTHAGE, IL 62321 (217) 357-9715: Non-Participating Provider: NO: 1376554592: CITY OF CHICAGO CITY OF CHICAGO EMS . . 7 0 obj
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Tulsa, Oklahoma 74106 (918) 596-3110. Ethics. DOR: Ambulance Release Form Fact Sheet DOR: Authorization for Release of Ambulance Charges We are required by law to follow these practices: City of Chicago's Notice of Privacy Practices. EMTs provide basic pre-hospital care to ill and injured patients. sapphire napa valley cabernet sauvignon adagio vineyard oakville 2018, anderson funeral home obituaries renfrew, ontario, tractor trailer accident on nys thruway today, County Commissioner District 2 Washington State, Madden 22 Roster Requirements By Position, counseling the culturally diverse quizlet. Authorization for release of ambulance charges form. 60602-1288 (312) 742-7065 . 4200 Indian Bayou Trail. To obtain a copy of your EMS report, please complete the Authorization For Release of Medical Information form.Once you have completed and submitted the Authorization For Release of Medical Information form, our medical/legal custodian of records will contact you to confirm your identity and retrieve any additional supporting documents needed to process the request. Records Appeals Officer. My dad had the chicago fire records for a copy of apparatus. Please see the notice here. }Xf3f9u!V32*Pex0Q{#F~ Y . Basic life support: $2,870.00 Advanced life support: $3,140.00 Oxygen: $28.00 (regardless of the amount) Mileage*: $19.00 per mile 0000008944 00000 n
D.1 EMS System Inventory Inspection Policy D.2 Confidentiality of Patient Records. This program is targeted towards individuals already employed in fire service, and particularly the City of Chicago Fire Department and Emergency Medical Services. What should I do now? 2022 PEOPLE BEHIND WECRUIT CHROMBIT ASIA. Municipal Channel; Public Information Requests; city of chicago ems records authorizationfundament vs fundamental. Otherwise, this authorization will expire ninety (90) calendar days 0000001609 00000 n
2021 All rights reserved - Branson Attractions LLC. Consolidated Submissions - HUD Grant Programs. In some instances a valid authorization will be required before the record may be released. 0000024209 00000 n
In order to submit all of the records that Medicare will require in the Appeals process, so they may reconsider payment of your claim, we have enclosed our patient authorization form to release the ambulance medical record . December 12, 2018. Monroe City of Waste Water Treatment Plant is located at W,, Monroe, WI 53566., Suite 100 Wausau WI 54403-6781. Like this great City, our Fire Department is rich with history and traditions. city of chicago ems records authorization. Get all the information or assistance you need about Austin, from the City's all day everyday information center. . The Vaccines For Children (VFC) program is a federally funded, state administered program that provides free vaccines to eligible children ages 18 and younger. Related Articles. Freedom of Information Section, Unit 114. City of Pullman is prohibited by law from negotiating prices. On 02/09/2021 Marshall filed an Other court case against City of Chicago EMS in U.S. Bankruptcy Courts. LAFD PHI Authorization Form ( rev. Strategic Plan 2021-2026. 01/01/2019) Page 1 of 2 EMS Records Custodian. BOX 4941 Chicago, Illinois 60680-4941 (312) 747-3811 AUTHORIZATION FOR AMBULANCE CHARGES (Release of Patient's Invoice) PLEASE PRINT Patient's Information: _____ Name It is an honor to be a part of the over 900 amazing and dedicated public servants who proudly serve the great City of Cincinnati and its 320,000 residents. ZIP Code. Use the Request Medical Records to request specific legal hospital records that are not available to you in MyChart, to be released to your MyChart account in the form of a PDF, for you to . Division of Housing & Community Development. 3510 S. Michigan Ave. Chicago, IL 60653. city of chicago ems phone number. If you have questions or need further assistance, please call the Police Records unit at 651-249-2600 or email at pdrecords@maplewoodmn.gov. The Illinois Freedom of Information Act (FOIA), 5 ILCS 140/1 et. ei` ;\#=.Nxb5}}tLuu=A=1Y0{Xx9{b6 Destin, FL 32541. city of chicago ems records authorization. Telephone number Email Mailing address Mail EMS/Trauma Systems Coordination Open Records Request Texas Department of State Health Services PO Box 149347 MC 1876 Austin, TX 78714-9347 Fax 512-206-3778 Email openrecords@dshs.texas.gov A list of reporting hospitals is included below. Much of the Illinois EMS licensing process can be accomplished online, using the links and forms available on this page. 155 42
2021 Truth in Taxation Worksheets. Emergency Medical Services (313) 596-5180, call 911 for Emergencies. Medical records for current or former Chicago Department of Public Health patients can be requested by email toCDPHCompliance@cityofchicago.org, via fax to (312) 747-9663, by phone to (312) 747-9672,or in person at any of our clinic sites. xref
200 North Main Street, 1620 FAX (213) 978-3813 . Commissioner of EMS - Contact Info. Fiscal Year 2022. submit applications to: department of records room 170, city hall philadelphia, pa 19107 for inquiries after submission call phila ems (215) 685-4205 . City employee benefits enrollment forms. Photograph. Box 222 Branson MO 65616. Just download and print deponent-specific forms, our general authorization or our HIPAA-compliant medical authorization form, obtain the signature of the name on record (or let us handle it for you) and then leave the rest to us. Fill out the whole form including the kind of records and dates of your visits. It is the responsibility of the patient to provide the Patient Services staff with their mailing address, current . 0000012825 00000 n
when did missouri become a right-to-work state; accordion paper folding; city of chicago ems phone number; By . Each City department is a separate public body responsible for maintaining its own records, so requests should be submitted to the department that maintains the records you want. EMS Medic 9 (based out of University Hospitals at that time . Fax: 773-702-7591 or 773-702-1855. Step 1: Click Here to Access Online Data Request. Click to report an STR complaint, or call the 24-hour hotline at 501-290-2950. . city of chicago ems phone number. <<6947A398B4D39647813B2E882C9B95CD>]>>
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I understand that the City of Chicago's health care component may not condition treatment, payment, enrollment or eligibility for benefits on whether I sign this authorization, unless the treatment is research-related.