LPCCN EMS Program Agency

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575 East Main Street
Batavia, NY 14020
Phone: 585-345-6110
Fax:      585-345-7452


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Resources/Forms

Lake Plains Community Care Forms:
Monthly PCR Cover Sheet - PDF
Agency Information Update Form - PDF
Agency Roster Form - PDF
Agency Roster Form - Excel
Generic Refusal Form - PDF
Generic Prehospital Electronic PCR Drop Sheet - PDF
ePCR Information
Naloxone Utilization Report

Programs:

Epinephrine Auto Injector (EpiPen) Program
AED / PAD Program
BLS Albuterol Program
BLS Nasal Naloxone Program
BLS 12-Lead Acquisition and Transmission
BLS CPAP

BLS Blood Glucometry Program


BLSFR (Basic Life Support First Response):
New BLSFR Application
BLSFR Update

WREMAC:
Annual Skills/PPA Forms:
WREMAC Annual Skills Resources Page
WREMAC Policy #2013-1 - Revised May 21, 2015 - PDF
Agency Roster Form - Excel
WREMAC PPA Application - Fillable PDF
WREMAC Annual Skills Evaluation Forms - All levels - PDF
WREMAC Skills Sheets - All Levels
WREMAC Preceptor Information:
Approved WREMAC Skills Evaluators List
WREMAC Preceptor Application - Fillable PDF

Medical Director/Level of Care Change Forms:
Medical Director Verification Form
Change in Medical Director Packet - Fillable PDF
WREMAC Level Of Care Change/Upgrade - Fillable PDF

575 East Main Street Batavia, NY 14020 Phone: (585)345-6110 Fax: (585)345-7452

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