This form is to be used by EMS Agencies to submit requests for distribution of Paper PCRs. The submission is based on the following tenets: 

• EMS Agency has complied with all Regional QI Components
• EMS Agency has submitted Paper PCRs via the Paper PCR Portal on a timely and consistent basis
• EMS Agency has no outstanding commitments to the Regional EMS Program Agency 

Any questions should be directed to emsdata@health.ny.gov prior to submitting the Paper PCR request.  EMS agencies not currently submitting paper PCRs through the Paper PCR Portal as of 07/01/2021 will be contacted by the Bureau of Emergency Medical Services and Trauma Systems