Forms & Resources

 

ALS Minimum Equipment List

Application and Approval for EMS Agency to Use e-PCR (DOH-5136)

BLS Syringe Epinepherine (Check and Inject)-

NCEMS RSI Application

RSI Agency Credentialling Form

Ketamine Utilization Screen

Patella Reduction Screen

Albuterol Squad Agreement

Blood Glucose Screen

Blood Glucometry Limited Laboratory Application

Regional Blood Glucometry Application

CPAP: BLS Agency Application Packet

        CPAP: BLS Screening Form

Excellence in EMS Form

Junior EMS Program Tool Kit

Medical Director Verification Form (DOH-4362)

 

Naloxone Administraion Program Requirements: Letter of Intent, Information sheet, MD Agreement, Medical Director Verification Form 

           - Naloxone Administration QI Call Review (Use Form)

           - Naloxone Equipment List and FAQs

 

NCEMS REMAC Quality Improvement Review

 

North Country Pre-Designated Landing Zones

 

PCR No Activity Report

Provider Update form

 

Public Access Defibrillation (PAD) Forms

      - PAD Collection Data form

      - PAD Collaborative Agreement (blank)

      - DOH-4135 form: Notice of Intent to provide PAD

Regional Medical Control Numbers

Regional Refusal Form and Instructions

Report of Child Abuse or Maltreatment

St. Lawrence County Mass Casualty (MCI) Response Plan

 

PCR’s may be picked up at the following locations:

Lewis County EMS 
Coordinator Office
5252 Outer Stowe St.
Lowville, New York
Jefferson County EMS
Meade Street
Watertown, New York

St. Lawrence County Public Safety (Tammy Labrake)
48 Court Street 
Canton, New York

0800-1600 M-F only

North Country EMS Progam Agency
120 Washington St. Suite 200
Watertown, New York


To Request More PCRs

Click on: ORDER
To assure proper and timely delivery please provide the following information:

  • In the SUBJECT window on the email type: PCR ORDER
  • In the body of the email type the following information:
  • Number of PCRs Requested.(PCRs are bundled in 250/pkg.or we can send your squad any number down to 25.)
  • Squad Name
  • Contact Person's Name
  • Address Where PCRs are to be sent.
  • Click SEND. When the email is opened you will receive a confirming response.

 

Resources

This is a free online medical dictionary search engine for definitions of medical terminology, pharmaceutical drugs, healthcare equipment, health conditions, medical devices, specialty terms and medical abbreviations. This site also offers links for Medical News, a Law Dictionary, a Legal Dictionary and a Computer Dictionary.