National Crime Information Center (NCIC) - City of Minneapolis

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To aid in the identification of the individual, if applicable, please mark the approximate location of any personal descriptors, i.e., scars, broken bones, moles, etc. Use the comments area to more fully describe any tattoos, scars, etc. Comments:
OPTIC INFORMATION ___________________________________________________________________________ Missing Person's Name Date of Birth ___________________________________________________________________________ Investigating Agency's Name Agency Case Number _______________________________________ Investigating Officer's Name ****************************************************************************** Glasses or Contact Lenses: Yes_____ No_____ If contact lenses. which type: (Circle one) Type of Frames__________________________ Soft Hard Semi Extended Wear Prescription: Right eye Comments: (Any diseases, scars, Left eye aid in the identification of the missing person) ______________________________________ Name of Optician. Optometrist. or Ophthalmologist _________________________________________ Street Address _________________________________________ City, State, and ZIP _________________________________________ Telephone Number AUTHORIZATION TO RELEASE MEDICAL RECORDS I am the parent/legal guardian/next of kin of the above-named missing person and I hereby authorize the release of medical records to assist criminal justice agencies in locating the missing person. ______________________________________ Signature of Parent/Legal Guardian/Next of Kin ______________________________________ Date ______________________________________ Relationship ______________________________________ Street Address ______________________________________ City. State. and ZIP ______________________________________ Telephone Number
Page 1 and 2: U.S. Department of Justice Federal
Page 3 and 4: ___________________________________
Page 5 and 6: o Foot (nonspecific) (FRC FOOT) o F
Page 7 and 8: o Arm, left (MOLE L ARM) o Arm, rig
Page 9 and 10: o Abdomen (DISC ABDOM) o Ankle, lef
Page 11 and 12: Medical Conditions and Diseases o H
Page 13 and 14: Missing Person's Name Date of Birth
Page 15: MEDICAL INFORMATION Missing Person'
Page 19 and 20: Dear Doctor: Agency Case # Since it
Page 21 and 22: TODAY'S DATE X-RAYS AVAILABLE? YES
Page 23 and 24: Code and Material Description Resto
Page 25 and 26: Code and Description Removable Appl
Page 27 and 28: Code and Description Other Characte

National Crime Information Center (NCIC) - City of Minneapolis

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