East Brentwood FD
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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
    Max file size: 20MB
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East Brentwood FD

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  • Home
  • About
    • Chiefs
    • Officers
    • Members
    • Commissioners
    • Apparatus >
      • Past Apparatus
    • History
  • News
  • Fundraising
  • Volunteer
  • Community
    • Fire Safety Tips
    • Links
  • Contact
    • Records Request >
      • PCR Request
      • Fire Incident Report Request
      • PCR and Fire Incident Report Request
  • Members