Prehospital Care Report (Version 5)

Here are camera-ready proofs of each page of the current (Version 5) paper Prehospital Care Report. These may be printed from this website and used as they are or reproduced by a professional printer. Please note, these proof are provided here for the convenience of the EMS Agencies. PCRs are available from the Bureau of Emergency Medical Services and Trauma Systems. Remember that all Prehospital Care Reports completed on the Version 5 paper document must be submitted through the Paper PCR Portal on the NYS Elite Site, EMS agencies with questions should contact their Regional Program Agency.

Copyright Permission: Although the PCR form is copyrighted by the New York State Department of Health, the Department gives permission for these to be reproduced by any entity regulated, contracted, or otherwise officially recognized by the Bureau of EMS. No further permission is required beyond this web page.

• Agency Copy (White Copy) - Front (PDF, 52KB, 1pg)
• Agency Copy (White Copy) - Back (PDF, 115KB, 1pg)
• Research Copy (Yellow Copy) - Front (PDF, 58KB, 1pg)
• Research Copy (Yellow Copy) - Back (PDF, 24KB, 1pg)
• Hospital Copy (Pink Copy) - Front (PDF, 52KB, 1pg)
• Hospital Copy (Pink Copy) - Back (PDF, 113KB, 1pg)
• DOH-3411 - Continuation Form (PDF, 52KB, 1pg)

For further information, please contact:

• NYS DOH Bureau of EMS
  875 Central Avenue
  Albany, NY 12206-1388
  518-402-0996 or EMSData@health.ny.gov