Instructions for completing a Version 5, NYS PCR

Bureau of EMS Policy Statement
Policy Statement #03-03
SubjectInstructions for completing a Version 5, NYS PCR


In 2003 the Bureau of Emergency Medical Services will introduce the fifth version (Version-5) of the New York State Prehospital Care Report (PCR)(DOH 3283) (sample attached). The primary purpose of the PCR remains a form used to document all prehospital care and pertinent patient information. The secondary purpose of the PCR is that of a data collection tool.

The Department of Health maintains a data system that tracks all inpatient care in hospitals by linking some of the data, Version-5 of the PCR will allow for the collection of additional data. That will allow linking prehospital patient care and the care provided by the emergency department and if admitted the hospital through to discharge. The linkage is obtained by certain identifying factors such as digits of the social security number and several of the characters in the patient's last name. This will permit the EMS system to better determine the effectiveness of the care given in a prehospital setting for quality assurance purposes.

Version-5 also includes characteristics necessary to utilize this form as a scannable instrument. Optical Character Recognition (OCR) will permit the form to be scanned and have the data extracted from it into useable tables. The only way this will be accomplished is if the person completing the form prints legibly. This will allow agencies, counties or regions to consider scannable systems locally.

Completing a Version-5 PCR:

While the form looks different, all of the previous items contained in a PCR are continued on the Version-5. Several items have been added and the format that information is entered has also been changed. Added to the Version-5 are:

  • Boxes for providing the patient's social security number (SS#)
  • An indication if the patient was defibrillated by a Public Access Defibrillation (PAD) Provider.
  • The patient's Date of Birth is now an 8-character entry requiring the century to be included. This field is located on the bottom line of the patient information box between the box for the patient's age and the circles for the patient's gender.

The other differences between Version-5 and the previous versions include:

  • Boxes are now provided for each character of agency and patient identifying information.
  • Please place one character in each box.
  • Do not draw lines through boxes that are not relevant to the patient.
  • Print carefully and legibly.
  • The Presenting Problem, Treatment Given and several other "Boxes" are now circles.
  • Please completely darken each circle that is applicable.
  • The Presenting Problems and Treatment Given sections are now printed with red ink. This red ink will not be recognized when the form is scanned. This feature is essential when the scanning process is implemented.
  • Do not use X or √ to indicate a selection.

There are no special tools required to complete the PCR, however it must be completed using black ink to be read by a scanner.

If you have any questions about completing a PCR please refer to DOH Policy Statement 02-05 (or any subsequent replacement of that document).

Issued and Authorized by:

Edward G. Wronski, Director

Bureau of Emergency Medical Services