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2. COVID-19 EFFORTS - CORRECTIONAL HEALTH SERVICES
   COVID-19 Efforts: To prevent or mitigate the potential spread of COVID-19 in any of the Maricopa County Sheriff Office (MCSO) jails, proactively, Maricopa County Correctional Health Services (CHS) is following the precautions recommended by the Maricopa County Department of Public Health and the CDC. View precautions and live updates on our COVID-19 dashboard.
4. CHS Clinical Liaison Contact Form
   The Correctional Health Services (CHS) Clinical Liaison is a non-emergency service for sharing health-related information. During regular business hours, Monday - Friday, 8:00 AM - 5:00 PM, your message will be forwarded to clinical staff where the patient is housed for follow-up.
6. Submitter Information
   Enter the information of the person submitting the form.
8. Last Name*
9. First Name*
10. Phone*
12. Email Address
14. Relationship to Patient*
    -- Select One --Legal RepresentativeRelativeCase ManagerFriendCourt StaffHealth Care Provider
18. Patient Information
    Enter the patient information below.
20. Last Name*
21. First Name*
23. Date of Birth
    Date of Birth
25. Booking Number
26. Criminal Case Number
28. Reason for contacting Correctional Health Services*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field