Forms
Incident Report Request
Clearcreek Fire District will provide public information as allowed for disclosure by the General Assembly of the State of Ohio.
Fire/Rescue Incident Reports
Fire and rescue incidents are available to the public, except for information regarding casualties and/or protected medical care, whether involving civilians or response personnel. Incidents with ongoing investigations will be available for release upon the conclusion of the investigation.
Please complete a Record Request Form (linked below) and email it to info@clearcreektownship.com. You can also mail the completed form to:
Clearcreek Fire District
735 Gardner Road
Springboro, OH 45066
Patient Care Reports
Emergency Medical Service records are private and confidential. Copies of patient care reports are only available to the following and must include proper identification and/or authorization. Lack of appropriate documentation will result in a denial of your request under the Health Insurance Portability and Accountability Act (HIPAA):
- Patient
- Must provide valid photo identification
- An assigned representative
- Must provide a valid HIPAA Medical Authorization Form signed by the patient
- Parent/Guardian
- A Parent or Guardian of a minor patient must provide a valid HIPAA Medical Authorization Form AND a copy of the birth certificate of the minor or an insurance card that lists both the parent/guardian and the minor child.
- Medical Power of Attorney
- If you are the patient’s Medical Power of Attorney (POA), you must provide a HIPAA Medical Authorization Form AND a complete copy of the POA.
- Executor or administrator of the patient’s estate
- If you are the executor or administrator of the patient’s estate, you must provide a valid HIPAA Medical Authorization Form AND a copy of the estate executor/administrator document.
- Next of Kin listed on a Death Certificate
- If you are the Next of Kin, you must provide a valid HIPAA Medical Authorization Form, a copy of the death certificate with your name listed as Next of Kin, and your photo ID.
To request a copy of a patient care report, complete a Record Request Form (linked below) and submit it along with the appropriate documentation to info@clearcreektownship.com. You can also mail the completed form and documents to:
Clearcreek Fire District
735 Gardner Road
Springboro, OH 45066
EMS Billing Information
Medicount Management oversees all billing for Clearcreek Township. As such, we do not have access to or information regarding patient billing. If you need a copy of an EMS bill, please contact Medicount Management at 800-962-1484 or visit Medicount.com.
If you have questions, feel free to contact Clearcreek Fire District at 937-748-2766 or info@clearcreektownship.com.
If you need additional guidance regarding Ohio Public Records Law, follow the link below to access the latest online version of The Sunshine Law Manual.
https://www.ohioattorneygeneral.gov/Legal/Sunshine-Laws/The-Sunshine-Laws-Manual
