BEMS Policies

• 12-02 Prehospital Care Reports (PDF)

• 12-03 Electronic PCR Data Submission (PDF)

• 21-04 Submission of Patient Care Reports as of July 1st, 2021 (PDF)

• NYSDOH 5136 Form

WREMAC Refusal Form

• WREMAC Refusal of Evaluation, Treatment, & Transport Form

• ​Request Printed Refusal Forms

Prehospital Care Report

*due to BEMS policy statement ​​21-04 (above), STEMS is no longer able to distribute paper PCRs and continuation forms. 

• Printable PCR

• Agency Copy (White Copy) - Front

• Agency Copy (White Copy) - Back

• Research Copy (Yellow Copy) - Front 

• Research Copy (Yellow Copy) - Back 

• Hospital Copy (Pink Copy) - Front 

• Hospital Copy (Pink Copy) - Back 

• DOH-3411 - Continuation Form