Request an EMS Report

Request a Patient Care Report

Requests for patient care report must be done in person at:
Elizabeth EMS Division
411 Irvington Avenue
Suite 310
Elizabeth NJ, 07208
Phone: 908-820-4040
Fax: 908-629-0292

Note: Only patient or legal guardian can request a copy of a patient care report.

Application Requirements

The following is information that is needed when completing the application:

  1. $5 Fee for Report
  2. Address Where the Incident Occurred
  3. Date of Incident
  4. Name of Responsible Party
  5. Proper Identification (Driver's License, Social Security Card, Government Issued ID)
  6. Telephone Number of Responsible Parties

Form of Payment

Form of payment must be one of the following:

  • Bank Check
  • Cash (Please Bring Exact Amount)
  • Money Order

In case of an emergency call 911.