Sarpy County E-911
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The Sarpy County E-911 Medical Alert Form is for use by the Sarpy County E-911 Communications Center, the law enforcement agencies, and fire/rescue departments which serve the citizens of Sarpy County, Nebraska. Its intention is to provide pre-arrival information to the responders to facilitate an enhanced response to your needs.
For example, when a telephone call from your residence comes into the Sarpy 911 Center, the computer screen at the operator position will show an 'alert' flag which will prompt the operator to read the special notes regarding the medical and other information which you have provided. This information will be relayed, as appropriate, to the law and/or medical personnel responding to assist you.
This information will be kept on file in the 911 Center and will not be released to anyone except as discussed above. Your signature on the bottom of the form certifies that you have the conditions listed and authorizes entry into the residence in case of an emergency.
If you have any questions regarding this form, please contact the Sarpy County Communications Center at 402-593-4397.
The Sarpy County E-911 Medical Alert Form
Click on the above "Medical Alert Form", print it off, fill in your information, and send it in. You must also complete an Acknowledgement of Receipt of Notice of Privacy Practices" as part of the new Federal HIPAA law. The acknowledgement form has been attached to the bottom of our Medical Alert File. Please read the complete Notice of Privacy Practices before you sign the acknowledgement.
A separate form should be completed for each individual member of the residence to whom conditions apply (i.e., one for husband, one for wife).
MAIL COMPLETED FORM TO: ATTN: E911 Center Supervisor, 1210 Golden Gate Drive, Papillion, NE 68046.