IN CASE OF EMERGENCY: DIAL 911

PCR REQUEST

PCR by Mail

To request a Patient Care Report (PCR) by mail, please follow the directions below:

  1. Completed Authorization For Release of Health Information Pursuant to HIPAA (OCA Official Form No.: 960). The form can be found here.
  2. The form must be notarized
  3. Mail to:


Manorville Community Ambulance
P.O. Box 719

Manorville, NY 11949
 

PCR Online

To request a Patient Care Report (PCR) online, please follow the directions below:
  1. Completed Authorization For Release of Health Information Pursuant to HIPAA (OCA Official Form No.: 960). The form can be found here.
  2. The form must be notarized
  3. Upload the form below