Home of the Monroe Township Fire Protection District's Web Site See pictures of the Station and it's apparatus Click to see the Duty Roster Click here to see
The Monroe Center
Fireman's Memorial Fund:
Dedicated to the Advancement of Ambulance and Rescue Services
Established April 1977
In Memory Of:

Peter J. Ciacco
Monroe D. Johnson
Nancy "Agnes" Crull
Guy Ludwig
Jacob L. Hildebrand
Edith Pickle
Gary Walker
Reino R. Kivikko
Donald E. Lichty
David S. Royster
Frank N. Reeder
Alta F. Parvis
Barbara D. Spray
Lena Johnson
Nancy L. McKnight
Hiram G. Adams
Oscar E. Hand
Meyrl L. Lundberg
Harry V. Morphey
Max D. Wight
Roy Rippentrop
Eugene Dodd
James Loman Moon III
Kay E. Rippentrop
J. Grant Adamson
Ellwood Atchison
Levi Johnson
Margaret A. Morphey
Eldo F. Jurgens
Kenneth Bearrows
Harold Terviel
C. Merrill Hildebrand
Carl O. Chesnut
Ingebret "Bert" Egeland
Ernest D. Ippen
Lloyd G. Taylor


Notice of Patient's Health Information Privacy Rights

 


104 West Street
Monroe Center, Illinois - 61052
Phone: (815)393-4222
Fax: (815)393-4466

PATIENT'S HEALTH INFORMATION PRIVACY RIGHTS

  • Patients have the right to receive and review a copy of MTF&APD Health Information Privacy Policy.
  • Patients may request that certain information not be disclosed to designated parties.
  • Patients may request that they be contacted only at a designated alternative address other than their home address.
  • Patients may make reasonable request of MTF&APD as to time and place for a copy of their protected health information (PHI), subject to a copying and mailing expense fee.
  • Patients have the right to request a correction of actual errors in the PHI.
  • Patients have the right, upon request, to be informed of disclosures of PHI by court orders, investigations and subpoenas.
  • Patients have a right to revoke, in writing, prior consents to disclosure of PHI.
  • Parents of minors or legal guardians can sign the release or acknowledgement of notice of disclosure form for their children and/or legal wards.

    • Click HERE to download the PDF Version of our HIPPA Form
     
    Click HERE to download the Word Version of our HIPPA Form

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    © 2007 Monroe Township Fire Protection District
    Monroe Center, Il 61052
    The Monroe Center
    Fireman's Memorial Fund:
    Dedicated to the Advancement of Ambulance and Rescue Services
    Established April 1977
    In Memory Of:

    Mary H. Walk
    Ethel Ehmen
    Kenneth "Bob" Wills
    Roger Gillespie
    Mary S. Randall
    Samuel J. Wingo
    Bernice E. Wendorf
    Ray Bradle
    Harold Veline
    Ruth E. Hildebrand
    Thomas 'Tom' I. Hawley
    Gertrude A. Ludwig
    Elizabeth M. Fenske
    Harry Wendorf
    Forrest "Bud" Klinefelter
    Harold Fisher
    Edwin A. Carls
    Norman J. Nelson
    Carl Krueger
    Edith J. Farlik
    Anna M. Nelson
    Milford O. Rothermel
    Mary Sue Russell
    John Bonne
    Frank Farlik
    Clifford King
    Deledu (Spray) Shearer
    W. Earl McKnight
    Edward Janicsko
    William H. A. Bohlman
    Gertrude A. Ludwig
    Johanna J. Hand
    Lillian Shook
    Mary H. Pickett
    Delrene B. Adrian
    John J. Rust Sr.
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