PEDESTRIAN/BICYCLIST/OTHER PEDESTRIAN LOCATION APPARENT CONTRIBUTING FACTORS 1. Pedestrian/Bicyclist/Other Pedestrian at Intersection HumanHumanHumanHumanHumanHumanHumanHuman HumanHumanHuman Vehicular Vehicle 19 2. Pedestrian/Bicyclist/Other Pedestrian Not at Intersection Vehicular 2.2. Alcohol InvolvementAlcohol Involvement41. Accelerator Defective 1 PEDESTRIAN/BICYCLIST/ 3.3. Backing UnsafelyBacking Unsafely 42. Brakes Defective OTHER PEDESTRIAN ACTION 4.4. Driver Inattention/DistractionInattention/Distraction***Driver Inattention/Distraction*43. Headlights Defective 1 1. Crossing, With Signal 8. Going to/From Stopped 5.5. Driver InexperienceInexperience***Driver Inexperience*44. Other Lighting Defects 2. Crossing, Against Signal School Bus 6.6. Drugs (Illegal)Drugs (Illegal) 45. Oversized Vehicle 7.7. Failure to Yield Right-of-WayFailure to Yield Right-of-Way Vehicle 3. Crossing, No Signal, Marked 9. Getting On/Off Vehicle 46. Steering Failure 1 20 Crosswalk Other Than School Bus 8.8. Fell AsleepFell Asleep 47. Tire Failure/Inadequate 4. Crossing, No Signal or 11. Working in Roadway 9.9. Following Too CloselyFollowing Too Closely48. Tow Hitch Defective Crosswalk 12. Playing in Roadway 10.10. IllnessIllness Illness Illness 49. Windshield Inadequate 5. Riding/Walking/Skating Along 13. Other Actions in RoadwayRoadway** 11.11. Lost ConsciousnessLost Consciousness50. Driverless/Runaway Vehicle Highway With Traffic 14. Not in Roadway (Indicate)(Indicate)** 12.12. Passenger DistractionPassenger Distraction 51. Tinted Windows 2 6. Riding/Walking/Skating Along 113.13 3 Passing.... or Lane Usage ImproperPassing 60. or LaneOther Usage VehicularVehicular* Improper* Vehicle Highway Against Traffic 21 14.14. Pedestrian/Bicyclist/Other Environmental 2 7. Emerging from in Front of/ Pedestrian Error/Error/Confusion Behind Parked Vehicle 61. Animal’s Action 15.15. PhysicalConfusion DisabilityPedestrianPhysical Error/ Disability 62. Glare 16.16. ConfusionPrescription MedicationPrescription Medication62. Glare TRAFFIC CONTROL 63. Lane Marking Improper/ 17.17. Traffic Control DisregardedTraffic Control Disregarded 1. None 8. RR Crossing Sign 13. Maintenance Inadequate Vehicle 2. Traffic Signal 9. RR Crossing Work Area 18.18. Turning ImproperlyTurning Improperly 64. Obstruction/Debris 22 64. Obstruction/Debris 2 3. Stop Sign Flashing Light 14. Utility Work Area 19.19. Unsafe SpeedUnsafe Speed 65. Pavement Defective 4. Flashing Light 10. RR Crossing Gates 15. Police/Fire 20.20. Unsafe Lane ChangingUnsafe Lane Changing66. Pavement Slippery 5. Yield Sign 11. Stopped School Bus- Emergency 21.21. Fatigued/Drowsy Fatigued/Drowsy 67. Shoulders Defective/ 3 Red Lights Flashing 6. Officer/Guard 16. School Zone 22.22. Cell Phone (hand-held)Cell Phone (hand-held) Improper 7. No Passing 12. Construction 20. Other*Other* 23.23. Cell Phone (hands-free)Cell Phone (hands-free)68. Traffic Traffic Control Control Device Device Work Area 68. Traffic Control Device Zone 24.24. Other Electronic DeviceDevice***Other Electronic Device* Improper/Non-WorkingImproper/Non-Working 25.25. Outside Car DistractionDistraction***Outside Car Distraction*69. View Obstructed/Limited LIGHT CONDITIONS New York State 226.26 6 Reaction.... to Uninvolved VehicleReaction to Uninvolved Vehicle 1. Daylight 227.27 7 Failure.... to Keep RightFailure to KeepDIRECTION Right N Vehicle NE 23 4 2. Dawn Department of Motor Vehicles 28.28. Aggressive Driving/Road RageRage***Aggressive OF Driving/Road Rage* 1 3. Dusk NW POLICE ACCIDENT REPORT 29.29. Passing Too CloselyPassing Too CloselyTRAVEL: 1 4. Dark-Road Lighted 30.30. Vehicle VandalismVehicle Vandalism 8 2 5. Dark-Road Unlighted MV-104COVMV-104COV (11/13) (7/18) 31.31. Texting Texting W 7 3 E ROADWAY CHARACTER *EXPLAIN IN ACCIDENT DESCRIPTION 332.32 2 Using.... On Board Navigation DeviceUsing On Board Navigation6 5 4Device Vehicle SW 24 1. Straight and Level If a question DOESDOES NOT APPLY, NOT APPLY, 33.33. Eating or DrinkingEating or Drinking 2 2. Straight and Grade 34.34. Listening/Using HeadphonesListening/Using Headphones SE 5 enter a dash (–).( –). S 3. Straight at Hillcrest PRE-ACCIDENT VEHICLE ACTION 4. Curve and Level 5. Curve and Grade If an answer is UNKNOWN, enter 1. Going Straight Ahead 13. Passing 6. Curve at Hillcrest an “X”. 2. Making Right Turn 14. Merging 16. Making Right Turn on Red 15. Backing Vehicle 25 ROADWAY SURFACE CONDITION LOCATION OF MOST 3. Making Left Turn 18. Police Pursuit 1 SEVERE PHYSICAL 17. Making Left Turn on Red 20. Other 6 1. Dry 3. Muddy 5. Slush * 2. Wet 4. Snow/Ice 6. Flooded COMPLAINT 4. Making U Turn 0. OtherOther** 1. Head 5. Starting from Parking 2. Face 6. Starting in Traffic WEATHER 7. Slowing or Stopping 3. Eye 8. Stopped in Traffic 1. Clear 5. Sleet/Hail/Freezing Rain 4. Neck Vehicle 6. Fog/Smog/Smoke 9. Entering Parked Position 26 2. Cloudy 5. Chest 2 7 3. Rain 0. Other*Other* 10. Parked 4. Snow 6. Back/Spine 11. Avoiding Object in Roadway 7. Shoulder-Upper Arm 12. Changing Lanes 8. Elbow-Lower Arm-Hand 9. Abdomen - Pelvis LOCATION OF FIRST EVENT 27 WHICH VEHICLE OCCUPIED 10. Hip-Upper Leg 1. On Roadway 2.Off2.Off Roadway 1. Vehicle No. 1 A. All-Terrain Vehicle (ATV) O.OtherO.Other * 11. Knee-Lower Leg-Foot TYPETYPETYPE OFOF OFACCIDENTACCIDENT ACCIDENT ---- COLLISIONCOLLISION -- COLLISION WITHWITH WITH 2. Vehicle No. 2 B. Bicyclist P. Pedestrian 12. Entire Body I. In-Line Skater S. Snowmobiler 1.1. Other1. Other Motor Motor Vehicle Vehicle 7. 7. 7. Deer Deer 2.2. Pedestrian2. Pedestrian POSITION IN/ON VEHICLE 8. 8. 8. Other Other pedestrian pedestrian TYPE OF PHYSICAL COMPLAINT 3.3. Bicyclist3. Bicyclist 10.10.1100. .Other Other Object Object 1. Driver 2-7. Passengers 4.4. Animal4. Animal (Not (Not (Not Fixed)Fixed) Fixed) *** 8. Riding/Hanging on Outside 1.1. Amputation Amputation 14. Whiplash 5.5. Railroad5. Railroad TrainTrain Train 2. Concussion SAFETY EQUIPMENT USED 2. Concussion 15. Crush Injuries COLLISIONCOLLISION WITH WITH FIXED FIXED OBJECT OBJECT 3.3. Internal Internal 16. Paralysis 1. None 4. Minor Bleeding First 4. Minor Bleeding 17. Severe Lacerations11.11. 11.LightLight Light Support/UtilitySupport/Utility Support/Utility PolePole Pole 28 2. Lap Belt 5.5. Severe Severe Bleeding Bleeding 12.12. 12.Guide Guide Rail-Not Rail-Not At End At End Event 3. Harness 6.6. Minor Minor Burn Burn 25.25. 25.Guide Guide Rail-End Rail-End 4. Lap Belt/Harness 7.7. Moderate Moderate Burn Burn 13.13. 13.Crash Crash Cushion Cushion 5. Child Restraint Only 8.8. Severe Severe Burn Burn 14.14. 14.Sign Sign Post Post 6. Helmet (Motorcycle Only) 9.9. FractureFracture - -Distorted Dislocation - Dislocation 15.15. 15.TreeTree Tree 7. Air Bag Deployed 10.10. Contusion Contusion - -Bruise Bruise 16.16. 16.Building/Wall Building/Wall 8. Air Bag Deployed/Lap Belt 11. Abrasion 11. Abrasion 17.17. 17.Curbing Curbing Vehicle 29 8 9. Air Bag Deployed/Harness 12.12. Complaint Complaint of of Pain Pain or Nausea 18.18. 18.FenceFence Fence 1 A. Air Bag Deployed/Lap Belt/Harness 13.13. None None Visible Visible 19.19. 19.Bridge Bridge Structure Structure B. Air Bag Deployed/Child Restraint 14. Whiplash 20.20. 20.Culvert/Head Culvert/Head Wall Wall SSSECONDECONDSECONDSECOND ECOND EJECTION FROM VICTIM’S PHYSICAL AND 21.21. 21.Median-Not Median-Not At End At End EVEEVENTEEVEVENT NTNT 1 2 3 In-Line Skater/ VEHICLE EMOTIONAL STATUS 26.26. 26.Median-End Median-End 8 8 Bicyclist 27.27. 27.Barrier Barrier 4 5 6 1. Not Ejected 1. Apparent Death C. Helmet Only 2. Unconscious 22.22. 22.Snow Snow Embankment Embankment D. Helmet/Other 2. Partially Ejected 23.23. 23.Earth Earth Embankment/Rock Embankment/Rock Cut/Ditch Cut/Ditch 3. Ejected 3. Semiconscious Vehicle 7 E. Pads Only 4. Incoherent 24.24. 24.FireFire Fire HydrantHydrant Hydrant 2 30 F. Stoppers Only 5. Shock 30.30. 30.Other Other Fixed Fixed Object Object** * 8 AGE SEX NO NOCOLLISION COLLISION M/F 6. Conscious 31.31. 31.Overturned Overturned 0. Other * INJUREDINJURED TAKENTAKEN 32.32. 32.Fire/ExplosionFire/Explosion Fire/Explosion 33.33. 33.Submersion Submersion 34.34. 34.Ran Ran Off OffRoadway Roadway Only Only 8 9 10 11 12 13 14 15 16 17 BY TO 18 40.40. 40.Other Other** * MV-104COV (7/18)

There are only 3 valid entries for injury code boxes 14, 15 and 16: 1. three dashes (-) meaning “does not apply” because no injury occurred. 2. three X’s meaning that an injury did occur but its complete nature is “unknown”. 3. three numeric injury codes which individually reflect the LOCATION OF MOST SEVERE PHYSICAL COMPLAINT, the TYPE OF PHYSICAL COMPLAINT and the VICTIM’S PHYSICAL AND EMOTIONAL STATUS. The injury codes in column 14, the LOCATION OF MOST SEVERE PHYSICAL COMPLAINT, are self- explanatory. Definitions of the injury codes for columns 15 and 16 are as follows: COLUMN 15 - TYPE OF PHYSICAL COMPLAINT: Column 16 — VICTIM’S PHYSICAL AND This column is used to describe the type of physical EMOTIONAL STATUS: Column 16 is used to describe injury sustained. The following are definitions of the the overall condition of the injured person. A victim’s Types of Physical Complaints for Column 15. status is defined as follows: 1. Amputation — Severed parts. 1. Apparent Death. 2. Concussion —Dazed condition as the result of a blow to the head. 2. Unconscious — Victim unaware of surroundings, and does not respond to verbal or 3. Internal — No visible injury, but signs of physical stimuli. anxiety, internal pain and thirst. 4. Minor Bleeding — Slight discharge of blood. 3. Semi-conscious — Victim not fully aware of surroundings. 5. Severe Bleeding — Steady flow of blood that is not controlled. 4. Incoherent — Lacking orderly continuity of thought. 6. Minor Burn — Reddening of the skin. 5. Shock — Depressed condition of all body 7. Moderate Burn — Reddening, blistering of skin functions, resulting from serious injury or incident. over large area. 8. Severe Burn — Reddening, blistering or charring 6. Conscious — Normal and aware of surroundings. of the skin over a large portion of the body. COLUMN 17 — INJURED TAKEN BY: The 9. Fracture — Distorted — Dislocation — Limb means by which an injured person is transported to a is disformed, bone is visible, evidence of bone hospital is to be recorded in Column 17. If the displacement. vehicle is an ambulance with a New York ambulance license plate, enter the license plate 10. Contusion/Bruise — Discoloration. number. For injured persons taken for emergency 11. Abrasion — Top layer of skin is scraped. medical treatment in a vehicle other than an ambulance with a NY ambulance license plate, enter 12. Complaint of Pain or Nausea — No visible signs the following codes in column 17: of injury, but victim makes verbal complaint. 9992 Helicopter 13. None Visible — No visible injuries, but victim 9993 Unknown Ambulance is other than normal. 9994 Coroner’s Van or Municipal Emergency Equip. 14. Whiplash — Complaint of neck and head pain. 9995 Private Vehicle 15. Crush Injuries — Part of body is pinned or 9996 Invalid Coach (Funeral) trapped and the victim cannot escape. 9997 Fire Vehicle 9998 Police Car 16. Paralysis — Any loss of movement that is not 9999 Police Ambulance voluntary. COLUMN 18 — INJURED TAKEN TO: See the 17. Severe Lacerations — Exposure of under tissue hospital codes on the bleed-through sheet. and/or oozing active bleeding. For additional information on filling out this form, refer to the Police Crash Report Submission Instructions (Form P-33). MV-104COV (11/13)(7/18) NEWNEW YORK YORK STATE STATE HOSPITAL HOSPITAL CODES CODES ALBANY COUNTY HOSPITALS ERIE COUNTY HOSPITALS LEWIS COUNTY HOSPITALS Albany Medical Center Hospital - 0101 Bertrand Chaffee Hospital - 1402 1402 Lewis County General Hospital - 2401 2401 Childs Hospital - 0104 Booth Memorial Hospital - 1410 1410 Eddy Cohoes Rehabilitation Center - 0107 Buffalo Columbus Hospital, Inc. - 1412 1412 LIVINGSTON COUNTY HOSPITALS Memorial Hospital - 0103 Buffalo General Hospital - 1404 1404 Dansville Memorial Hospital - 2501 2501 St. Peter’s Hospital - 0102 Buffalo General Hospital - Deaconess Center - 1414 1414 Mt. Morris Tuberculosis Hospital - 2502 2502 V.A. Hospital - 0106 Buffalo Psychiatric Center - 1421 1421 Nicholas H. Noyes Memorial Hospital - 2503 2503 Childrens Hospital - 1413 1413 MADISON COUNTY HOSPITALS ALLEGANY COUNTY HOSPITALS Erie County Medical Center - 1405 1405 Cuba Memorial Hospital - 0201 Community Memorial Hospital - 2601 2601 Gowanda Psychiatric Center - 1407 1407 Oneida City Hospital - 2602 2602 Memorial Hospital of William & Gertrude F. Jones - 0202 Kenmore Mercy Hospital - 1416 1416 BRONX COUNTY HOSPITALS Lafayette General Hospital - 1417 1417 MONROE COUNTY HOSPITALS Bronx Municipal Hospital Center - 70037003 Mercy Hospital - 1418 1418 Genesee Hospital - 2708 2708 Bronx Psychiatric Center - 70047004 Millard Fillmore Hospital - 1401 1401 Highland Hospital - 2701 2701 Bronx V.A. Hospital - 70057005 Millard Fillmore Suburban Hospital - 1423 1423 Lakeside Memorial Hospital - 2702 2702 Calvary Hospital Inc.- 70067006 Our Lady of Victory Hospital - 1408 1408 Monroe Community Hospital - 2709 2709 Lincoln Hospital and Medical Health Center - 70107010 Roswell Park Memorial Institute - 1420 1420 Park Ridge Hospital - 2703 2703 Our Lady of Mercy Medical Center - 70117011 Sheehan Memorial Hospital - 1406 1406 Rochester General Hospital - 2704 2704 Montefiore Hospital and Medical Center - 70127012 Sisters of Charity Hospital - 1411 1411 Rochester Psychiatric Center - 2707 2707 North Central Bronx Hospital - 70267026 Sheridan Park Hospital - 1415 1415 St. Mary’s Hospital - 2705 2705 Our Lady of Mercy Medical Center Durso Pavilion - 70167016 St. Francis Hospital - 1419 1419 Strong Memorial Hospital - 2706 2706 Prospect Hospital After Care - 70177017 St. Joseph Hospital of Cheektowaga - 1422 1422 V.A. Medical Center - 1403 1403 MONTGOMERY COUNTY HOSPITALS St. Barnabas Hospital - 70197019 Amsterdam Memorial Hospital - 2801 2801 The Bronx-Lebanon Hospital Center Concourse Division - 7020 7020 ESSEX COUNTY HOSPITALS St. Mary’s Hospital - 2802 2802 The Bronx-Lebanon Hospital Center Fulton Division - 70217021 Adirondack Medical Center - Lake Placid Site - 1504 1504 Montefiore Hosp. J. D. Weiler Hosp. of Elizabethtown Community Hospital - 1501 1501 NASSAU COUNTY HOSPITALS A. Einstein Coll. of Med. - 70227022 Moses-Ludington Hospital - 1503 1503 Central General Hospital - 2908 2908 Union Hospital - 70237023 Franklin General Hospital Medical Center - 2913 2913 Westchester Square Hospital - 70257025 FRANKLIN COUNTY HOSPITALS Hempstead General Hospital - 2907 2907 Montefiore Center, Henry and Lucy Moses Division - 70267026 Adirondack Medical Center - Saranac Lake Site - 1605 1605 H.I.P. Hospital of Long Island - 2903 2903 Alice Hyde Memorial Hospital - 1602 1602 Long Beach Hospital - 2900 2900 BROOME COUNTY HOSPITALS Mercy General Hospital - 1603 1603 Long Island Jewish Hillside Medical Center - 2918 2918 Binghamton Psychiatric Center - 0305 Sunmount Hospital - 1604 1604 Lydia E. Hall Hospital - 2912 2912 Medicenter Division of United Health Services - 0303 Massapequa General Hospital - 2917 2917 Our Lady of Lourdes Memorial Hospital - 0304 FULTON COUNTY HOSPITALS Mercy Hospital - 2915 2915 United Health Services-Binghamton General Hospital Div. - 0301 Johnstown Hospital - 1701 1701 Mid Island Hospital - 2910 2910 United Health Services-Wilson Hospital Division - 0302 Nathan Littauer Hospital - 1702 1702 Nassau County Medical Center - 2909 2909 North Shore University Hospital - 2901 2901 CATTARAUGUS COUNTY HOSPITALS GENESEE COUNTY HOSPITALS Batavia V. A. Hospital - 1803 1803 North Shore Univ. Hosp. at Glen Cove - 2902 2902 Olean General Hospital - Main - 0401 South Nassau Community Hospital - 2911 2911 Olean General Hospital - West - 0405 Genesee Memorial Hospital - 1801 1801 St. Jerome Hospital - 1802 1802 St. Francis Hospital - 2916 2916 Parkway Primary Care - 0406 Syosset Community Hospital - 2919 2919 Tri-County Memorial Hospital - 0404 HERKIMER COUNTY HOSPITALS Winthrop University Hospital - 2905 2905 Herkimer Memorial Hospital - 2101 2101 CAYUGA COUNTY HOSPITALS NEW YORK COUNTY HOSPITALS Auburn Memorial Hospital - 0501 Little Falls Hospital - 2102 2102 Mohawk Valley General Hospital - 2103 2103 New York Downtown Hospital - 7201 CHAUTAUQUA COUNTY HOSPITALS Bellevue Hospital Center - 7202 7202 Brooks Memorial Hospital - 0601 JEFFERSON COUNTY HOSPITALS Beth Israel Medical Center - 7203 7203 Jamestown General Hospital - 0602 Camp Drum Hospital - 2205 2205 Coler Memorial Hospital - 7204 7204 Lake Shore Hospital Inc. - 0603 Carthage Area Hospital - 2201 2201 Cabrini Medical Center - 7258 7258 WCA Hospital at Jones Memorial Health Center - 0606 Edward J. Noble Hospital of Alexandria Bay - 2202 2202 Columbia-Presbyterian Medical Center - 7205 7205 Westfield Memorial Hospital - 0604 House of the Good Samaritan - 2203 2203 Doctors Hospital - 7208 7208 Womans Christian Association - 0605 Mercy Hospital of Watertown - 2204 2204 Flower and Fifth Avenue Hospital - 7209 7209 Goldwater Memorial Hospital - 7212 7212 CHEMUNG COUNTY HOSPITALS Kings County Hospitals Harlem Hospital Center - 7215 7215 Arnot-Ogden Memorial Hospital - 0701 Baptist Medical Center of New York - 7141 7141 Hospital for Joint Diseases - 7216 7216 St. Joseph’s Hospital - 0702 Brookdale Hospital Center - 7103 7103 Hospital for Special Surgery - 7218 7218 Brooklyn Hospital Center Downtown Campus - 7105 7105 Joint Diseases North General Hospital - 7259 7259 CHENANGO COUNTY HOSPITALS Brooklyn V.A. Hospital - 7107 7107 Lenox Hill Hospital - 7223 7223 Chenango Memorial Hospital Inc. - 0801 Brooklyn Hospital Center Caledonian Campus - 7108 7108 Manhattan Eye, Ear and Throat Hospital - 7226 7226 Carson C. Peck Memorial Hospital - 7109 7109 CLINTON COUNTY HOSPITALS Manhattan State Hospital - 7227 7227 Community Hospital of Brooklyn - 7110 7110 Manhattan V.A. Hospital - 7228 7228 Champlain Valley Physicians Hospital - 0901 Coney Island Hospital -7111 -7111 Plattsburgh Air Force Base Hospital - 0903 Medical Arts Center Hospital - 7229 7229 Flatbush General Hospital - 7113 7113 Memorial Hospital for Cancer & Allied Diseases - 7230 7230 COLUMBIA COUNTY HOSPITALS Hospital of the Holy Family Division of Catholic Med. Ctr. - 7115 7115 Metropolitan Hospital Center - 7231 7231 Columbia-Greene Medical Center, Columbia Division - 10011001 Jewish Hospital and Medical Center - 7118 7118 Mount Sinai Hospital - 7233 7233 Kings County Hospital Center - 7119 7119 New York Hospital - 7234 7234 CORTLAND COUNTY HOSPITALS Kings Highway Hospital - 7120 7120 New York Eye and Ear Infirmary - 7237 7237 Cortland Memorial Hospital Inc. - 11011101 Kingsbrook Jewish Medical Center - 7121 7121 New York Infirmary - 7239 7239 Long Island College Hospital - 7124 7124 New York University Medical Center - 7241 7241 DELAWARE COUNTY HOSPITALS Lutheran Medical Center - 7126 7126 Community Hospital - 12011201 Rockefeller University Hospital - 7246 7246 Maimonides Medical Center - 7127 7127 St. Luke’s Roosevelt Hospital Center - 7247 7247 Delaware Valley Hospital - 12021202 Methodist Hospital of Brooklyn - 7128 7128 Margaretville Memorial Hospital - 12031203 Saint Clare’s Hospital and Health Center - 7249 7249 St. John’s Interfaith Medical Center - 7132 7132 St. Luke’s Hospital Center - 7251 7251 O’Connor Hospital, Division of Bassett Health Care - 12051205 St. Mary’s Hospital of Brooklyn - 7133 7133 The Hospital - 12061206 St. Vincent’s Hospital and Medical Center - 7252 7252 State University Hospital Downstate Medical Center - 7134 7134 Presbyterian Hospital in NYC A. Pavilion Division - 7260 7260 DUTCHESS COUNTY HOSPITALS Victory Memorial Hospital - 7137 7137 Presbyterian Hospital in the City of New York - 7261 7261 Highland Hospital - 13041304 Wyckoff Heights Medical Center - 7139 7139 Hudson River Psychiatric Center - 13011301 Woodhull Medical and Mental Health Center - 7142 7142 Northern Dutchess Hospital - 13051305 University Hospital of BrooklynBrooklyn - 7143 7143 St. Francis Hospital - 13071307 Wyckoff Heights Med. Ctr. Jackson Heights Division - 7144 7144 V.A. Medical Center, Castle Point - 13021302 Vassar Brothers Hospital - 13061306 MV-104COV (11/13)(7/18) NEW YORKNEW STATE YORK HOSPITAL STATE HOSPITAL CODES CODES NIAGARA COUNTY HOSPITALS RENSSELAER COUNTY HOSPITALS SULLIVAN COUNTY HOSPITALS Degraff Memorial Hospital - 3101 3101 Leonard Hospital - 41014101 Community General Hosp. of Sullivan Co. - G. Herman Div. - 52015201 Inter-community Memorial Hospital - 3102 3102 Samaritan Hospital - 41024102 Community General Hosp. of Sullivan Co. - Harris - 52045204 Lockport Memorial Hospital - 3103 3103 St. Mary’s Hospital - 41034103 Mount. St. Mary’s Hospital - 3104 3104 TIOGA COUNTY HOSPITALS Mount View Hospital - 3105 3105 RICHMOND COUNTY HOSPITALS Tioga General Hospital - 53015301 Niagara Falls Memorial Medical Center - 3106 3106 Bayley Seton Hospital - 7408 7408 TOMPKINS COUNTY HOSPITALS Ransomville General Hospital - 3107 3107 Doctor’s Hospital of Staten Island - 7401 7401 Richmond Memorial Hospital and Health Center - 74027402 Robert Packer Hospital - 54025402 ONEIDA COUNTY HOSPITALS Sea View Hospital and Home - 7403 7403 Tompkins Community Hospital - 54015401 Childrens Hospital and Rehabilitation Center - 32013201 St. Vincent’s Medical Center of Richmond - 7404 7404 ULSTER COUNTY HOSPITALS Faxton Hospital, Inc. - 32033203 Staten Island Hospital - The Urgent Care Center - 7405 7405 Benedictine Hospital - 55035503 Griffis A.F.B. Hospital - 32093209 U.S. Public Health Service Hospital (Marine Hospital) -­ Ellenville Community Hospital - 55025502 Marcy Psychiatric Center - 32023202 7406 7406 Kingston Hospital - 55015501 Rome Hospital & Murphy Memorial Hospital - 32043204 Staten Island University Hospital - North - 74097409 Rose Hospital - 32063206 Staten Island University Hospital - South - 7410 7410 WARREN COUNTY HOSPITALS St. Elizabeth Hospital - 32073207 Glens Falls Hospital, Inc. - 56015601 St. Luke’s Memorial Hospital Center - 32083208 ROCKLAND COUNTY HOSPITALS Utica Psychiatric Center - 3205 3205 Good Samaritan Hospital - 43024302 WASHINGTON COUNTY HOSPITALS Helen Hayes Hospital - 43054305 Emma Laing Stevens Hospital - 57015701 ONONDAGA COUNTY HOSPITALS Nyack Hospital - 4303 4303 Mary McClellan Hospital - 57025702 Community-General Hospital - 33023302 N.Y.S. Rehabilitation Hospital - 43044304 Crouse-Irving Memorial Hospital - 33053305 Rockland Psychiatric Center - 4301 4301 WAYNE COUNTY HOSPITALS St. Joseph’s Hospital - 33043304 Summit Park Hospital - Rockland Co. Infirmary - 4306 4306 Lyons Community Hospital - 58025802 St. Mary’s Hospital of Syracuse - 33063306 Meyers Community Hospital - 58035803 State University Hospital Upstate Medical Center - 33073307 ST. LAWRENCE COUNTY HOSPITALS Newark-Wayne Community Hospital, Inc. - 58045804 V.A. Hospital - 33013301 A. Barton Hepburn Hospital - 44014401 Canton-Potsdam Hospital - 4406 4406 WESTCHESTER COUNTY HOSPITALS ONTARIO COUNTY HOSPITALS Clifton Fine Hospital - 44034403 Blythedale Childrens Hospital - 59015901 Canandaigua V.A. Hospital - 3401 3401 Edward J. Noble Hospital - (Canton) - 4404 4404 Burke Rehabilitation Center - 59025902 Clifton Springs Hospital and Clinic - 3403 3403 Edward J. Noble Hospital - (Gouverneur) - 44084408 Community Hospital at Dobbs Ferry - 59035903 Frederick Ferris Thompson Hospital - 34023402 Messina Memorial Center Hospital - 44054405 FDR V.A. Hospital in Montrose - 59115911 Geneva General Hospital - Long Term Care - 34043404 St. Lawrence Psychiatric Center - 4407 4407 Hudson Valley Hospital Center - 59085908 Lawrence Hospital - 59065906 ORANGE COUNTY HOSPITALS SARATOGA COUNTY HOSPITALS Mount Vernon Hospital - 59205920 Arden Hill Hospital - 3505 3505 Adirondack Regional Hospital - 45024502 New Rochelle Hospital Medical Center - 59235923 Cornwall Hospital - 3506 3506 Benedict Health Center - 45034503 Northern Westchester Hospital - 59075907 Horton Memorial Hospital - 3503 3503 Saratoga Hospital - 4501 4501 NY Hospital-Cornell Medical Center-Westchester Div. - 59165916 Middletown Psychiatric Center - 3504 3504 Phelps Memorial Hospital - 59095909 St. Anthony Community Hospital - 3507 3507 SCHENECTADY COUNTY HOSPITALS St. Agnes Hospital - 59195919 Mercy Community Hospital of Port Jervis - 35083508 Bellevue Maternity Hospital - 4605 4605 St. John’s Riverside Hospital - 59105910 St. Luke’s Hospital of Newburgh - 3509 3509 Ellis Hospital - 4603 4603 St. Joseph’s Hospital - 59255925 Tuxedo Memorial Hospital Health Care Center - 35013501 St. Clare’s Hospital - 46014601 St. Vincent’s Hospital and Medical Center of NY - 59175917 West Point Hospital - 3514 3514 SCHOHARIE COUNTY HOSPITALS United Hospital - 59125912 Westchester County Medical Center - 59055905 ORLEANS COUNTY HOSPITALS Community Hospital of Schoharie County, Inc. - 4701 4701 White Plains Hospital - 59135913 Medina Memorial Hospital - 3602 3602 SCHUYLER COUNTY HOSPITALS Yonkers General Hospital - 59145914 OSWEGO COUNTY HOSPITALS Schuyler Hospital - 4801 4801 WYOMING COUNTY HOSPITALS A.L. Lee Memorial Hospital - 3701 3701 SENECA COUNTY HOSPITALS Wyoming County Community Hospital - 60016001 Oswego Hospital - 3702 3702 Seneca Falls Hospital - 4901 4901 OTSEGO COUNTY HOSPITALS Taylor-Brown Health Care Center and Nursing Home - 49024902 YATES COUNTY HOSPITALS Aurella Osborn Fox Memorial Hospital - 38013801 Willard Psychiatric Center - 49034903 Soldiers and Sailors Memorial Hospital - 61016101 Mary Imogene Bassett Hospital - 3803 3803 STEUBEN COUNTY HOSPITALS OUT-OF-STATE PUTNAM COUNTY HOSPITALS Bath V.A. Hospital - 5005 5005 Canada - 92709270 Julia L. Butterfield Memorial Hospital - 3901 3901 Bethesda Hospital - 50015001 Connecticut - 93709370 Putnam Hospital Center - 3902 3902 Corning Hospital - 5002 5002 Massachusetts - 91709170 Queens County Hospitals Ira Davenport Memorial Hospital - 5003 5003 New Jersey - 96709670 Astoria General Hospital - 7301 7301 St. James Mercy Hospital - 5004 5004 Pennsylvania - 94709470 Booth Memorial Medical Center - 7302 7302 Vermont - 90709070 Boulevard Hospital - 7303 7303 SUFFOLK COUNTY HOSPITALS Any Other - 99709970 Catholic Medical Center - Brooklyn-Queens, Inc. 7304 7304 Brookhaven Memorial Hospital - 51165116 City Hospital Center at Elmhurst (Satellite) - 7305 7305 Brunswick Hospital Center - 51115111 Creedmore Psychiatric Center - 7306 7306 Central Islip Psychiatric Center - 51175117 Deepdale General Hospital - 7307 7307 Central Suffolk Hospital - 51015101 Flushing Hospital and Medical Center - 7308 7308 Community Hospital of Western Suffolk - 51125112 Catholic Medical Center-Brooklyn-Queens, Inc. St. St. Eastern Long Island Hospital - 51215121 Joseph’s Hospital Div. - 7309 7309 Good Samaritan Hospital - 51085108 H.I.P. Hospital, Inc. - 7310 7310 Huntington Hospital - 51045104 Jamaica Hospital - 7311 7311 J.T. MatherJ.T. Mather Hospital - 51105110 Long Island Jewish-Hillside Medical Center - 73147314 Kings Park Psychiatric Center - 51135113 Mary Immaculate Hospital Div. of Cath. Med. Ctr.,Ctr., Pilgrim Psychiatric Center - 51075107 Brooklyn-Queens - 73157315 Southampton Hospital - 51195119 Parkway Hospital - 7316 7316 Southside Hospital - 51145114 Parsons Hospital - 7317 7317 South Oaks Psychiatric Center - 51095109 Peninsula Hospital Center - 7318 7318 St. Charles Hospital - 51225122 Physician’s Hospital - 7319 7319 St. John’s Smithtown Hospital - 51155115 Queens Hospital Center - 7321 7321 Suffolk State School - 51335133 St. John’s Episcopal Hospital South Shore Div. - 73227322 University Hospital Stony Brook - 51345134 St. Albans Naval Hospital - 7323 7323 V.A. Medical Center - Northport - 51185118 St. John’s Queen Hospital Div. of Cath. Med. Ctr.,Ctr., Brooklyn-Queens -7324 -7324 St. Mary’s Hospital for Children - 7325 7325 Laguardia Hospital - 7326 7326 MV-104COVMV-104COV (11/13) (7/18) TRUCK/BUSTRUCK/BUS CLASSIFICACLASSIFICATION CLASSIFICATIONTION

TheThe t abletable below below gives gives the the codes codes that that should should be be entered entered on on the the MV-104A MV-104AMV-104A (Police (Police Accident Accident Report) Report) in in the the boxbox (V (Vehicleehicle Type”. Type”. These These codes codes apply apply to to all all buses buses except except school school buses, buses, and and to to all all trucks trucks except except pick-up pick-up trucks.trucks.

ForFor example, example, an an accident-involved accident-involved vehicle vehicle that that is is a a flat-bed flat-bed truck truck with with two two axles axles on on the the tractor tractor and and two two on on thethe trailer trailer would would be be coded coded G3; G3; a a New New York York City City transit transit authority authority bus bus would would be be coded coded A. A.

WeWe also also request request that that the the investigating investigating officer officer provide provide the the following following information information about about cargo cargo in in the the “Accident“Accident Description/Officer Description/Officer Notes” Notes” section, section, where where applicable applicable. .

WasWas vehicle vehicle authorized: authorized: and/or and/or labeled labeled to to transport: transport:

1. 1.to to be be oversize oversize (height (height and/or and/or width width load) load) 3. 3.flammable/explosive flammable/explosive materials? materials? 2. 2.to to carry carry an an overweight overweight load? load? 4. 4.poisonous/corrosive poisonous/corrosive materials? materials? 5. 5.radioactive radioactive materials? materials? 6. 6.other other hazardous hazardous cargo cargo (explain? (explain?

TYPEType OF of VEHICLEVehicle TYPE OF VEHICLE (1) (2) (3) (1)BOX (2)TANK PLATFORM(3) BOX TANK PLATFORM ...... •••• '--''--' c C1 C2 C3 C1 C2 c ..2 Axle Single Unit C3 ..2 Axle Single Unit 0 01 02 03 0 01 02 ..3 Axle Single Unit 03 ..3 Axle Single Unit E E1 E2 E3 E ..4 Axle Single Unit E1 E2 E3 ..4 Axle Single Unit N N u F F1 F2 F3 u M F ..1 Axle Trailer 2 Axle Tractor F1 F2 F3 M ..1 Axle Trailer 2 Axle Tractor B B E G G1 G2 G3 E R 911115 G 9111152 Axle Trailer. 2 Axle Tractor G1 G2 G3 R 2 Axle Trailer. 2 Axle Tractor 0 0 F H H1 H2 H3 H F 3... Axle Trailer. 3 Axle Tractor H1 H2 H3 A 3... Axle Trailer. 3 Axle Tractor A x I ~ 11 12 13 x L I 11 12 L E ~2 Axle Trailer, 3 Axle Tractor 13 E s 2 Axle Trailer, 3 Axle Tractor s J J1 J2 J3 J 3... Axle Trailer 3 Axle Tractor J1 J2 J3 3... Axle Trailer 3 Axle Tractor K K1 K2 K3 K 2.... Axle Trailer 3 Axle Truck K1 K2 K3 2.... Axle Trailer 3 Axle Truck L L1 L2 L3 L ~~~\e&(~J~~sTractor L1 L2 L3 ~~~\e&(~J~~sTractor M ""' M1 M2 M3 M ""'Other Combinations M1 M2 M3 Other Combinations BB --- UU A ---TRANSIT BUS A A A SS A TRANSIT BUS A A A EE S OVER-THE ROAD SS B OVER-THE ROAD B B B B COACH B B COACH B