In the lexicon of investigators who search for missing persons, individuals are categorized into three groups: whereabouts, skips, and criminals. Most missing persons are not actually missing; rather, their whereabouts are unknown to the investigator. Because these individuals, known as whereabouts, are not attempting to conceal themselves from others, they can be readily traced. Skips are individuals who may have failed to pay bills, left families, or defaulted on other obligations. They are not considered criminals, but they do not wish to be found and may be actively avoiding detection. Criminals, in contrast, may go to great extremes in order to hide their location. Unfortunately, there is no way for the investigator to know if a patient is wanted by law-enforcement officials. If the patient is avoiding efforts by law-enforcement officials to find him or her, the scientific investigator's search will be more difficult as well. Whereabouts and most skips can be readily located, whereas criminals are much more difficult to find.
Some patients will not be found despite an investigator's best efforts. These patients include criminals as well as victims of foul play, tax evaders, participants in witness-protection programs, and individuals who have falsified their information. An investigator's ability to find all other types of patients is limited only by the amount of time, energy, and money available for the process.
Initiation of the Search Process
The easiest way to find someone is not to lose track of them in the first place. Identifying data on each patient should be obtained at the initial visit. Essential information includes the patient's full legal name, nicknames, maiden name, date of birth, Social Security number, current address (including zip code), and occupation. It is also helpful to know how the person prefers to be listed in the telephone directory. In addition, we recommend that each patient provide the name, address, and telephone number of a reliable contact person who will always know how to reach him or her. This contact person could be a family member or a close friend with whom the patient intends to remain in communication. Because older Americans are less mobile, it is usually easier to locate a patient through his or her parents' address, especially if the patient's name has changed. The Social Security number is by far the most important piece of vital information available to the investigator. Each Social Security number is unique and applies to one particular individual. A person may move, change his or her name, switch jobs, and so on, but his or her Social Security number will remain unchanged.
It is important to note that each child should have a Social Security number by the age of one year for tax-reporting purposes. Therefore, the investigator should ask parents to provide that information as soon as it becomes available. If possible, the names and Social Security numbers of siblings should be included with the information on both parents. Until the child is old enough to work and to drive, he or she will be difficult to find without information about the parents. Similarly, after the parents have died, the patient will be difficult to locate without his or her own unique identifying data.
The United States Postal Service
Depending on the amount of time available, an investigator may consider sending a simple letter to the last known address of a patient and waiting for a reply. The United States Postal Service no longer provides a copy of change-of-address cards that have been filed by other people. It will, however, forward a letter. The letter should be stamped by the sender with one of two messages: (1) Attention Postmaster, Address Correction Requested, Postage Guaranteed or (2) Attention Postmaster, Do Not Forward, Address Correction Requested. In the first case, the letter will be forwarded to the new address if the patient moved within the previous year. The investigator will be notified of the new address and will be charged for the forwarding postage. In the second case, the letter will be returned along with the new address. Sending a letter is inexpensive and may be effective. If the patient moved more than one year previously, however, the effort will not succeed because the postal service only provides letter-forwarding and change-of-address information for one year.
Various alumni associations across the country send out letters each year with a request for change-of-address information from the post office. If the individual has moved within the year, the new address will be returned to the sender. In order for this method to be effective, a stamped postcard must be generated every year for each patient, and time and personnel are required to update the retrieved information. Investigators embarking on a prospective clinical trial could incorporate this method into the protocol.
The Telephone
If an investigator has a limited amount of time in which to locate patients or if use of the postal service fails, telephone services should be tried. If the last known telephone number is incorrect, an operator can check if there is a new listing. The area codes for the surrounding region should be checked as well; most people who move stay within the same county9. Operators in large cities often have access to multiple area codes, all of which can be searched simultaneously. The charges vary according to region, but they are usually low. In California, the charge is thirty-five cents per call and includes a search for as many as three names. Additional names generate additional charges. If the investigator has a long list of names and wishes to search multiple area codes, the charges will multiply rapidly.
If the investigator is searching for a large number of patients, he or she may prefer to provide the phone company with a list of names and wait for the reply, particularly if there are many area codes in the surrounding region.
Some patients may have changed their telephone number to an unlisted number. Unlisted numbers are contained in a separate database that can be searched with the assistance of a supervisor. The rules vary by phone company, but searches of this database generally can be performed if the investigator provides his or her medical license number and explains the medical purposes involved.
The databases searched by telephone operators are updated continuously, which is clearly advantageous. White-page listings for the entire United States, however, can be purchased on compact disk (CD-ROM) for a relatively small cost (approximately thirty dollars) and can be searched on any home computer. If the investigator is searching for a large number of patients, this may be a good investment. The information is updated yearly, so it is important to check the package label before purchase to be sure that the disk is current.
A source of information that is often overlooked is the crisscross, or reverse, directory. A reverse directory, which can usually be found in the local library, lists telephone numbers by address. This type of directory is not available on compact disk. If an investigator is having difficulty locating a patient's current telephone number because the patient has moved or the number has become unlisted, it is possible to obtain the numbers of the patient's neighbors through this directory. Neighbors can be a valuable source of information. If a neighbor is not familiar with the missing patient, it is possible to ask for the name and telephone number of another neighbor who perhaps has a closer relationship with the patient. If the patient has moved, the neighbor may be able to provide the name of the city where the patient lives. During this process, it is important that the investigator be honest about the reason for the call and be careful not to reveal any protected information.
If the patient rented his or her residence, it may be possible to obtain the number of the previous landlord. If a security deposit was owed or if rent was outstanding, the landlord may have already found the patient and be willing to share helpful information.
An investigator also may attempt to contact relatives or previous employers of the patient. Nordberg recently described a technique for conducting this type of telephone interview. With permission from the author, we have summarized his technique as follows.
Identify yourself by name but do not identify your facility unless asked to do so. Know to whom you are speaking. State the problem and ask for help. Make your request courteous and friendly but sound confident. Encourage the informant through easy conversation by asking leading questions naturally and tactfully. Ask for the new address, place of employment, and telephone number only. Let the person at the other end of the line offer any additional information. Make use of the psychological pause by waiting after each question. Leave it up to the person to make the next move. All questions from the informant should be followed by a combination answer and question. This will keep you in control of the conversation. Know how and when to end your call. Be honest and ethical at all times, and be sure to thank the source for his or her time.
The Internet
Another option is to go online. Searching for patients with use of the Internet is faster and potentially less expensive than doing so with use of the telephone. A number of Web sites include white-page listings that are updated on a regular basis, usually quarterly. With the exception of user time, the services are free of charge. The databases are maintained by private individuals or companies, and many of them contain more than 100 million residential listings.
The drawback of the Internet is that sometimes many sites must be searched before the person in question is found. This can be time-consuming if the investigator is searching for a large number of patients or if the Internet connection is slow. It is important that the investigator try each source before moving on to the next site. Failure to locate a number on one site does not mean that a search of another site will be fruitless. Some of these online databases include:
206.129.166.101 (Infospace "The Ultimate Directory")
www.semaphorecorp.com (National Address Browser)
www.databaseamerica.com
www.four11.com
www.yahoo.com/reference/whitepages
www.angelfire.com/pages0/ultimates
www.yahoo.com/search/people
www.switchboard.com
www.whowhere.com
www.lookupusa.com
We have found the angelfire.com site to be particularly useful because it provides access to multiple telephone-number search engines in one location. If a patient is not found on the first attempt, another engine can be searched easily. If the telephone number has been disconnected but an address is given, a personal visit to the patient may be appropriate. The angelfire.com site is capable of generating a detailed map for assistance.
The databases differ slightly with regard to the type of information that they will accept for use in the search. Depending on the information available to the investigator, one site may be more helpful than another. With some effort, these sites can also be used to find the telephone numbers of neighbors who live on the same street where an individual used to reside; this method is similar to the technique of using a crisscross, or reverse, directory.
The Department of Motor Vehicles
In the past, a very effective method that could be used to locate missing persons was to search the records of the state Department of Motor Vehicles. Most individuals have a current driver's license or identification card issued through the Department of Motor Vehicles that lists their name, address, date of birth, Social Security number, and physical characteristics. Concerns regarding privacy and safety have prompted some states not to release these records as public information, but the information may be obtained if a so-called good cause can be demonstrated. What constitutes a good cause can be very subjective and is likely to be determined by the supervisor on duty. Searching the records of the Department of Motor Vehicles for personal or vehicle-registration information is usually subject to a fee, which varies by state.
Voter Registration Files
The use of voter registration files has been placed under similar restrictions in many states. The records, which are usually located at the county courthouse, contain the voter's full name, date and place of birth, employer, and voting district. If access to these files is not restricted in the state, a careful review may be a simple way to obtain useful information. The limitation of this technique is that the investigator must review the records in person; thus, the process is time-consuming.
Credit Bureaus
For years, the nation's three major credit bureaus (TRW, Transunion, and Equifax) have been accumulating credit information, which is accessed by businesses every time an individual applies for a loan or a credit card. Each bureau maintains a computerized database that is updated continuously. In fact, TRW, Transunion, and Equifax each receives and processes nearly one billion records on the nation's consumers monthly.
Credit bureaus acquire information from a number of different sources, including all types of financial statements, motor-vehicle registrations, magazine subscription lists, voter registration files, white-page listings, postal address updates, the National Death Index, and so on. Their databases are immense and are growing at an astounding pace.
Most financial institutions and hospitals already have access to at least one of these services for the purpose of verifying credit information. Access is easily obtained though a modem connection with use of customized software. Consumer inquiries can be performed quickly and effectively.
The Fair Credit Reporting Act10 stipulates that credit information may be requested from a consumer reporting agency for certain permissible purposes only. Obtaining a credit history without cause is a federal crime and can lead to serious penalties, including fines and imprisonment. However, it is not necessary to obtain a complete credit history in order to find a patient. As the Fair Credit Reporting Act does not contain an exact definition of what constitutes a legitimate business need and does not specify the procedure for verifying such a need, personal information held by credit agencies is readily available to anyone who is willing to pay for it.
Each of the major credit-reporting services has developed products that are ideal for the purpose of locating missing patients. For a little more than one dollar, the vital information on any individual can be obtained without a formal credit check. This avoids any legal problems and greatly reduces the cost of the search. Vital information includes the patient's name, current and previous addresses, Social Security number, age, employer, and spouse's name. A positive search result should provide the investigator with enough information to contact the patient by letter or telephone.
TRW offers two products, TRW Social Search and TRW Address Update, which can be used to search a database that contains information on more than 190 million individuals. TRW Social Search provides the individual's name, year of birth, current address and as many as ten previous addresses, spouse's name, and employer after the individual's Social Security number is entered. As many as twenty Social Security numbers may be entered at once for efficiency. If the Social Security number is not known, the patient's name and last known address are sufficient to perform a search with use of TRW Address Update. The output includes the patient's current address and Social Security number. TRW does not provide current telephone numbers; however, if desired, a current telephone number should be easy to obtain with use of the patient's current address, as described previously.
Transunion offers four different products, which can be used to search two separate databases. TRACE, TRACEplus, and ReTRACE all work from the same database, which contains records on more than 220 million individuals. TRACE is an automated national search system that enables the investigator to ascertain or confirm a patient's name and address by entering the patient's Social Security number. TRACEplus is a more informative search system that provides the patient's name, address, aliases, date of birth, telephone number, and employment information (when available). ReTRACE provides the individual's Social Security number, telephone number, and date of birth, and as many as three addresses, after the individual's name and last known address are entered.
Transunion also maintains another database, the ATLAS directory, which is compiled from a number of different sources, including telephone directories, marketing companies, and the circulation departments of popular magazines. A variety of different types of reports can be generated from this database depending on the data that are available for input and the desired output. An investigator can use the ATLAS database to generate a list of the patient's current and previous neighbors and to perform surname searches according to geographic area. The ATLAS directory currently contains records on more than 150 million individuals.
Equifax offers two products, DTEC and ID REPORT, that can be used to find missing persons, again without violating the Fair Credit Reporting Act. With use of DTEC, the investigator can search the nationwide Equifax database of 190 million consumer files by entering the individual's Social Security number. The output includes the patient's name and telephone number as well as his or her current and former addresses. With use of ID REPORT, the investigator is able to search through the same database by entering the patient's name and last known address; the output includes the most current reported information.
Overall, these databases are the most comprehensive tracking systems available. Gaining access to these sources is easy and completely legal. Although an internal electronic record is made of every inquiry, no external mark appears on the patient's credit report. Systematic updating makes these databases extremely accurate. These systems provide instant access to hundreds of millions of individuals for a relatively minor cost; most searches cost less than a dollar and a half each. With the exception of the ATLAS directory, which charges ten cents, none of these systems charge for a search that fails to yield data.
All of these databases are remarkably efficient in terms of both time and cost. The necessary software can be easily installed on a personal computer that is equipped with a modem. A start-up cost is involved, and monthly charges apply whether the investigator uses the system or not. Most hospitals have the systems running and can request user-specific codes for accurate distribution of billing.
Letter-Forwarding
Even when an investigator is not able to locate a missing patient despite his or her best effort, the government may know how to contact the patient. Both the Social Security Administration and the Internal Revenue Service have offices of disclosure that will, on occasion and with good reason, forward a letter to an individual. The letter-forwarding policy is restrictive because of the wide variety of reasons that one individual may wish to contact another.
In order for a letter to be forwarded, certain criteria must be met11. First, the investigator must have a strongly compelling reason for wanting to locate the missing person. Second, the investigator must demonstrate that the missing person would want to be aware of the contents of the letter. Third, all other methods of contact must have been exhausted.
To have a letter forwarded, the investigator must send a cover letter to a local Social Security office, stating the reason for needing to contact the missing person. The letter to be forwarded must be submitted in a plain, unsealed, unstamped envelope bearing only the missing person's name and Social Security number.
A doctor or other health-care professional who wishes to contact a person for the purpose of health-related follow-up will be charged a fee (approximately three dollars). The fee is waived if the investigator is attempting to inform the person of a disease about which the person might be unaware. Inquiries involving 100 individuals or more should be sent to OEER, 6401 Security Boulevard, Baltimore, Maryland 21235. OEER will respond directly to such inquiries and provide additional instructions.
The investigator should be aware that many employees in the Social Security Administration are unaware of the written policies regarding the forwarding of letters. If the investigator is polite and patient and emphasizes the importance of the request, his or her effort may be fruitful. If difficulties are encountered at the local Social Security Administration office, it is possible for the investigator to appeal to the main offices in Baltimore. The amount of time that elapses between the date on which the request is made and the date on which the letter is forwarded generally is about two months.
Other Sources
Although government sources may not be readily available to assist in the search for missing patients, the so-called information age has brought with it the development of vast computerized super-databases. The average American generates a substantial trail of information during a lifetime. This trail consists of credit-card transactions, driver's licenses, bank accounts, insurance policies, magazine subscriptions, property holdings, professional licenses, medical records, divorce and bankruptcy documents, civil litigation proceedings, and so on. Almost all of these records are maintained on computer and are often sold to venders, who package them for various purposes.
FINCEN is the federal government's Financial Central Record Database, which contains records of financial transactions involving all Americans. The database includes information on credit-card transactions, bank accounts, taxes, and so on. This source, which has been called the granddaddy of all databases, is accessible to authorized governmental employees only8. Although the scientific investigator cannot use FINCEN to locate patients, the size of this database illustrates that massive amounts of information pertaining to the nation's residents are continuously being collected and recorded in computerized format.
National Credit Information is a private entity that maintains another enormous database. Unlike FINCEN, however, this database is available to the public. National Credit Information provides information to attorneys, professional brokers, private investigators, collection agencies, credit services, property managers, and employers. This one service provides access to vast amounts of information, including consumer credit information (350 million files), Social Security number-tracing (300 million files), address-updating (250 million files), nationwide crisscross telephone and address information (ninety million files), nationwide driving information, nationwide alpha name searches, nationwide Workers' Compensation information, nationwide criminal history records, and death record searches through the Social Security Master Death Record File (forty-one million files).
Not everyone qualifies to use this service. The user must be associated with a legitimate business and must have a legitimate need for access. There is a substantial start-up fee, and charges (usually between five and fifty dollars) are incurred for each report generated. Although this database is extremely powerful, it is also expensive. Fortunately, most of this same information can be obtained from other sources for far less money.