Hatzalah Chapter PCR Onboarding

Fill out this form to request a custom PCR narrative builder for your chapter. We'll use your information to configure the tool to match your local hospital destinations and protocols. Once submitted, our team will be in touch within 1-2 business days.

Chapter Information

Chapter / Division Name *

City *

State *

County

Zip Code *

Primary Contact

Full Name *

Role

Email Address *

Phone Number

Service Details

ePCR Platform Used

Number of Active Units

Hospital Destinations

Enter your zip code and search radius to find nearby hospitals, or type a hospital name to search.

Search by hospital name or zip code

Radius (miles)

Or add a hospital manually

Protocols & Custom Language

Special Narrative Language

Does your chapter require any special language in the PCR narrative? If so, please describe it here.

Excluded Treatments / Interventions

Select any treatments or interventions that are NOT covered or not permitted in your area of service:

Additional protocol notes or requirements

Form Customization Requests

Let us know if you'd like anything changed on the BLS or ALS form — field names, dropdown options, default values, hospital names, unit numbers, or anything else specific to your chapter.

BLS form changes requested

ALS form changes requested

Anything Else?

Additional notes or questions

✓

Request Submitted!

Thank you. We've received your chapter information. A team member will be in touch within 24 hours to set up your custom PCR narrative builder.

Contact Support

Hatzalah Chapter PCR Onboarding

Request Submitted!