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279 <br />.1 <br />RECORDS DISPOSITION DOCUMENT <br />NO. <br />PAGE 1 OF 1 PAGES <br />1. AGENCY NAME and ADDRESS <br />Indian River County Fire Rescue <br />4225 43rd Avenue <br />Vero Beach, FL 32967 <br />2. AGENCY CONTACT (Name and Telephone Number) <br />Ellen Salm <br />(772) 226 - 3865 Ext. <br />3. <br />NOTICE OF INTENTION: The <br />one) <br />• a. Destruction <br />scheduled records listed in Item 5 are to be <br />• b Microfilming and Destruction <br />disposed of in the manner checked below (specify only <br />►1 c. Other Scanned and Destruction <br />4. SUBMITTED BY: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for <br />the .. have be-. iIly justified, and that further retention is not required for any litigation pending or imminent. <br />r55,5i , <br />Signature Name and Title <br />tZ, '1 I"1 Date <br />5. LIST OF S:114 <br />• S J <br />a. <br />Schedule <br />b. <br />Item <br />c. <br />Title <br />d <br />. Retention <br />e. <br />Inclusive <br />f. <br />Volume <br />In <br />9. <br />Disposition <br />Action and <br />No. <br />No. ' <br />Dates <br />Cubic <br />Feet <br />Date <br />Completed <br />After <br />Authorization <br />GS4 <br />80 <br />Patient Medical Records <br />7 CY <br />2010 Through 2014 <br />Totlal <br />5 <br />Scev.,.ed <br />sr <br />Shredded <br />MA/ <br />6. DISPOSAL AUTHORIZATION: Disposal for the above listed <br />records is authorized. Any deletions or modifications are indicated. <br />/ <br />7. <br />i <br />SPOSAL CERTIFICATE: The above listed records have been <br />posed oft the manner and on the date shown in column g. <br />icn <br />Ul�u� .. �Iu„..„ J..) a k/ice-, S 6 ' 41-1 <br />6 <br />/.-L.' / „ <br />Sig ture Date <br />Donna RC'C rdS Si-ct-r-r <br />,,Cus •dian/Records-Management 'raison Off i er D to <br />+•T- <br />Nam Title <br />Witness <br />279 <br />.1 <br />