Get Ny Doh-4461 2016-2026

The NY DOH-4461 form is essential for reporting incidents involving emergency medical services. This guide will help you navigate the online completion of the form clearly and effectively.

Follow the steps to fill out the NY DOH-4461 form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the name of the EMS service and the NYS EMS agency code in the appropriate fields.
3. Provide the address details including street, city, state, zip code, and county where the incident occurred.
4. Fill in the contact person information, including their name, phone number, and title.
5. Select the regional EMS council and choose your agency type by checking the appropriate box.
6. Specify the incident location by selecting from options such as residence, roadway, or medical facility.
7. Document the date and time of the incident in the designated fields.
8. Indicate the unit status at the time of the incident by selecting from the available options.
9. Identify the type of incident and provide the number of persons injured or deceased as applicable.
10. Complete relevant sections based on the incident type, ensuring all necessary fields in sections 1 to 6 are filled out.
11. Review all entered information for accuracy.
12. Once complete, save your changes, and choose to download, print, or share the filled form as needed.

Start completing your NY DOH-4461 form online today!