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Request to Remove Identifying Information for Children with Special Needs

Ohio Revised Code 3705.30 requires physicians, hospitals and freestanding birthing centers to report children under the age of five years with specific disorders to the Ohio Department of Health, Ohio Connections for Children with Special Needs (OCCSN) program. This information is used to inform parents/guardians about available services that may be helpful to them. All information collected for this program is confidential and shared only for referrals to programs and services. Ohio Revised Code 3705.33 allows parents to request information about their child be removed from the OCCSN data system.

If you would like your child’s information removed from the OCCSN system, click the "Download" button located to the right of this page to find the form with fillable fields. Please be aware that by requesting the removal of personally identifiable information from the OCCSN system, you will not receive information about services your child may be eligible for. No services will be denied based on this request to remove information from OCCSN.

Please submit the completed form via e-mail, mail, or fax.

Email: bcmh.occsn@odh.ohio.gov

Mail: Ohio Department of Health
         Ohio Connections for Children with Special Needs
         246 N. High Street
         Columbus, OH 43215

Fax: 614.564.2504

For questions or additional information, please call 614.728.2427