Follow the steps to successfully complete the NY PR1 form online

1. Click the ‘Get Form’ button to access the NY PR1 form and open it in your preferred editing tool.
2. In Section A, provide your customer information. Indicate your relationship to the patient by selecting from the options: ‘Patient (self)’, ‘Parent or guardian of a minor’, or ‘Other authorized representative’. Fill in your name, address, city, state, zip code, and telephone number.
3. Proceed to Section B to fill out the patient information. Enter the patient’s name, ACRPCR number, date of birth, and the last four digits of the Social Security number. If applicable, provide the invoice number, incident date, and incident time, selecting either ‘AM’ or ‘PM’.
4. Complete the incident details, including the incident address, borough, and zip code. If known, include the receiving hospital information.
5. If you possess an FDNY invoice for emergency transportation, make sure to include the key details in the ‘FDNY Invoice Details’ section for better identification of the incident.
6. Review the completed form for accuracy. Save your changes and prepare your required supporting documents based on your relationship to the patient.
7. Submit your form and supporting documents electronically through myPatientEncounters, in-person at the FDNY headquarters, or by postal mail, ensuring to include a stamped self-addressed envelope if mailing it.

Complete the NY PR1 form online today to request your Pre-Hospital Care Reports efficiently.