PCR by Mail

To request a Patient Care Report (PCR) by mail, please follow the directions below:

1. Completed Authorization For Release of Health Information Pursuant to HIPAA (OCA Official Form No.: 960). The form can be found here.
2. A $50.00 check made payable to: East Brentwood Fire Department. 
3. Mail to:

East Brentwood Fire Department
Attention: Records Request
26 Fulton Street
Brentwood, NY 11717

PCR by Fax

To request a Patient Care Report (PCR) by fax, please follow the directions below:

1. Completed Authorization For Release of Health Information Pursuant to HIPAA (OCA Official Form No.: 960). The form can be found here.
2. Fax to: (631) 231-5670
3. A $50.00 check made payable to: 

East Brentwood Fire Department
Attention: Records Request
26 Fulton Street
Brentwood, NY 11717

PCR Online

To request a Patient Care Report (PCR) online, please follow the directions below:

1. Completed Authorization For Release of Health Information Pursuant to HIPAA (OCA Official Form No.: 960). The form can be found here.
2. Upload the form below
3. Pay online