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Southern Tier Health Care System, Inc.
  • Home
    • Our Mission
    • Our Team
    • Board of Directors
    • CEO Update
    • Our Facility >
      • Request Building Use
    • News
    • Consulting
  • Our Programs
    • Emergency Medicine >
      • Upcoming EMS Courses
      • Current Provider Resources >
        • Request Copy of EMT Card
        • Education & Training
        • Annual Skills
        • DOH Inspection Prep
        • EMS Agency Update
        • New or Returning Provider
        • Applications & Forms
        • PCR
        • EMS Protocols
        • Public Access Defib
        • Safe Transport
      • Southern Tier EMT-B Academy
      • Paramedic Program
      • BEMS Forms and Portal Links
      • STEMS Newsletter Archive
      • SWREMS, WREMAC & BEMS
    • Safe Kids >
      • Safe Kids Events
      • Coalition Calendar
    • Cribs for Kids
    • Overdose Prevention >
      • Report Narcan Use
      • Narcan Training
      • Prescription Drug Safety
      • Matters Network >
        • Leave Behind Attestation
      • Drug Disposal Resources
      • Needle/Sharps Disposal
      • Overdose Prevention News
      • Catt County Jail Narcan
      • Allegany County Jail Narcan
    • Caregiver Navigation
    • Sexual Assault Forensic Examiner >
      • Become a SAFE Provider
    • Health Insurance
    • File of Life
    • Blood Drives
    • American Heart Association Training
    • Stop the Bleed
    • Distance Learning
  • *NEW* Telehealth
    • Telehealth Room Locations
    • Reserve a Telehealth Room
    • Telehealth Resources
    • Telehealth Troubleshooting
    • Telehealth Room Policies
    • Frequently Asked Questions
  • Contact Us
  • Donate

PCR and Refusal

Request Refusal Forms

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

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*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
​

© 2025 Southern Tier Health Care System, Inc. All Rights Reserved. 
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Southern Tier Health Care System, Inc.
​150 North Union Street, Olean, NY 14760

  • Home
    • Our Mission
    • Our Team
    • Board of Directors
    • CEO Update
    • Our Facility >
      • Request Building Use
    • News
    • Consulting
  • Our Programs
    • Emergency Medicine >
      • Upcoming EMS Courses
      • Current Provider Resources >
        • Request Copy of EMT Card
        • Education & Training
        • Annual Skills
        • DOH Inspection Prep
        • EMS Agency Update
        • New or Returning Provider
        • Applications & Forms
        • PCR
        • EMS Protocols
        • Public Access Defib
        • Safe Transport
      • Southern Tier EMT-B Academy
      • Paramedic Program
      • BEMS Forms and Portal Links
      • STEMS Newsletter Archive
      • SWREMS, WREMAC & BEMS
    • Safe Kids >
      • Safe Kids Events
      • Coalition Calendar
    • Cribs for Kids
    • Overdose Prevention >
      • Report Narcan Use
      • Narcan Training
      • Prescription Drug Safety
      • Matters Network >
        • Leave Behind Attestation
      • Drug Disposal Resources
      • Needle/Sharps Disposal
      • Overdose Prevention News
      • Catt County Jail Narcan
      • Allegany County Jail Narcan
    • Caregiver Navigation
    • Sexual Assault Forensic Examiner >
      • Become a SAFE Provider
    • Health Insurance
    • File of Life
    • Blood Drives
    • American Heart Association Training
    • Stop the Bleed
    • Distance Learning
  • *NEW* Telehealth
    • Telehealth Room Locations
    • Reserve a Telehealth Room
    • Telehealth Resources
    • Telehealth Troubleshooting
    • Telehealth Room Policies
    • Frequently Asked Questions
  • Contact Us
  • Donate