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Press Release/Events - Vial of Life Program - What is a Mounder? - Firefighter's Association Selling T-Shirts - HIPAA Form
What is the Vial of Life Program?
We will use this as a “lifeline” to you or your family if something should happen to you. It doesn’t matter what age you are or in what health you are. This form will help us help you. If for some reason you became ill and cannot talk with us and there is no one around that can, we can use this to better help you. This form will tell us more about you. Information that is vital in how we take care of you. The information contained in this form can, and will help save your life.
What Information is on this Form?
This form will include information about your past medical history, allergies, the medications you take, along with emergency contact information, which hospital you would like to go to, who your family doctor is, and your information like address birthday ect.
What is Past Medical History?
Past Medical History is any History that involves any surgeries you have had in the past. Any heart attacks, “funky” heart beats, like murmurs, or atrial fibrillation. You should put any Lung Diseases or Arthritis. Basically anything that your doctor tells you. Matter of fact contact your doctor and have them help you.
Where do I put The Form?
After you finish filling out the form place the form in a plastic baggy and place that in your kitchen freezer. Yes your freezer!!. This will allow the ambulance crews a standard place to look. If you like, make a copy of the form and place it in your wallet or purse. This will come in handy if you were in another town or away from home and something happened to you.
Who Will See This?
In accordance with the HIPAA, Health Insurance Portability and Accountability Act, law that was placed into affect on April 14, 2003 for our Fire District, the only people that will see this is the Ambulance crew that responds to your home and your nurse or doctor at the hospital. No one else will ever see this form. For more information regarding HIPAA, contact the Privacy Officer at 815-734-4322.
What if I Need Help Filling This Out?
Stop by the Firehouse anytime and we will help you fill out or answer any questions that we can. You can even have your Blood Pressure and Pulse Checked!! If you need help with your past medical history, allergies, or medications you can contact your family doctor and they can get that information for you.
How do I Contact the Firehouse?
If it is an Emergency, dial 911. You can call our Non-Emergency Number at (815)734-4322, or stop in at 15 East Center St anytime.
