Skip Navigation
Utility Menu
Skip Navigation LinksHome / Health & Human Services / Mental Health / LEDS Medical Database Form

LEDS Medical Database Form

Side Menu

​LEDS Medical Database Instructions

HB 3466, passed during the 2009 legislative session, directs the State Police to create and maintain a medical health database within the Law Enforcement Data System (LEDS).  The intent of the legislation was to provide law enforcement agencies with information to assist persons with a qualifying illness or condition in obtaining medical, mental health and social services.  An individual with one of these qualifying conditions may voluntarily provide this information to the Marion County Health Department for entry into LEDS.  The information will only be accessed in order to provide necessary information to law enforcement officers and other emergency personnel when responding to an emergency.

Enrollment in the LEDS Medical Database is voluntary, revocable and not a precondition for receiving mental health treatment at the Health Department.  Enrollment is good for three years unless revoked earlier.

In order to be eligible for enrollment an individual must:

  • Have a qualifying illness or condition; and
  • Give written consent by completing and signing the enrollment form; or
  • Provide written consent by a person authorized to make medical decisions for the individual, if the individual is subject to a guardianship, advanced directive for health care, declaration for mental health treatment or power of attorney that authorizes the person to make medical decisions for the individual; or
  • A parent of the individual, if the individual is under 14 years of age.

NOTE:  If you are a person authorized to make medical decisions for the individual please attach proof to the consent form.

Qualifying Conditions:

  • Dementia
  • A developmental Disability
  • A mental health DSM Axis 1* diagnosis such as mood disorders, anxiety disorders, psychotic disorders, substance use disorders and impulse control disorders
  • A physical or behavioral disorder that causes disorientation or otherwise may impede an individual's ability to interact effectively with a law enforcement officer

The enrollment form must be witnessed by at least two adults, and at least one witness shall be a person who is not:

  1. A relative of the individual by blood, marriage or adoption or
  2. An owner, operator or employee of a health care facility in which the individual is a patient or resident.

The individual's primary care physician, mental health service provider, or any relative of the physician or provider may not be a witness. 

If you have questions about completing the form, or want to revoke a form that has been entered into LEDS please contact Eva McCammon at 503-588-5351. 

PDFClick here for the fillable LEDS Medical Database Consent Form.  Please complete the form, attach any proof of guardianship or other authorizations if applicable and submit to:

Marion County Health & Human Services
Attn: Eva McCammon
3180 Center Street NE
Salem, OR 97301

Once we receive a completed form a mental health supervisor will contact you to verify the information to be entered into LEDS. You may request revocation/removal of the LEDS entry at any time by contacting the Health Department at the address or phone number above.