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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. Mail to:

East Moriches Community Ambulance
P.O. Box 295
East Moriches, NY 11940

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. Upload the form below.
PCR Request Form