Patient Care Report (PCR) Online Request - Mastic Volunteer Ambulance Company

Patient Care Report (PCR) Online Request Instructions

Obtaining a copy of your Patient Care Report (PCR) can be an essential step in managing your medical care, insurance claims, or legal documentation. To ensure timely and secure processing of your request, please follow the instructions below:

Step 1: Complete the Required Authorization Form

To request your medical records, you must complete the Authorization for Release of Health Information Pursuant to HIPAA (OCA Official Form No. 960). This form ensures compliance with federal privacy regulations and allows us to release your health information appropriately.
Download and complete OCA Form No. 960.
Ensure all required fields are filled out accurately, including your signature and date.

Step 2: Upload the Completed Form

Once you have filled out the authorization form:
Use the upload field provided below to submit your completed document.
Ensure the file is legible and in a supported format (PDF preferred).

Indicates Required Field

Last Name

Email Address Required

Phone/Mobile Required

Form Upload Required

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HIPAA Privacy Notice

Under the Health Insurance Portability and Accountability Act (HIPAA), all requests for medical records, including PCRs, must be accompanied by valid patient authorization.

We are committed to protecting your confidential health information. Your PCR will only be released:

To the patient named in the report, or

To a person with documented legal authority (e.g., parent, legal guardian, or power of attorney)