1. Navigate to the EMS Setup located in the Incident Documentation module.
2. Select on the Custom Elements section.
3. Select the Add button within the Custom Questions subsection.
4. When adding Custom Elements required fields will be identified by the (*) symbol.
5. Enter a Custom Element ID.
- This is the unique identifier to accompany the new question. This ID may come from a NEMSIS State Data Set (e.g. "emsa.E1") or be defined by an agency.
6. Within the Title, the text entered here is what becomes visible to a provider filling out an ePCR.
7. From the Data Type dropdown select Text/String.
- Use this data type to allow a text only answer or create a custom dropdown list for the custom question.
8. Recurrence will allow you to answer the custom question multiple times within the ePCR if set to yes.
9. You can choose to include this custom element within the XML Export by using the dropdown and selecting Yes or No.
10. From the Usage dropdown you are able to set if the custom question should be mandatory, required, recommended or optional for the provider when documenting an ePCR.

NOTE: If Required or Recommended is selected you will be able to set Not values to choose within the ePCR.
11. You are able to set Not values using the dropdown and selecting on all that will apply for this custom question.
12. Set any Pertinent Negatives from the dropdown that should apply to the question being asked.
13. Insert the definition of this question.
- This is used for internal tracking.
14. From the Path section you are able to add this question to a Custom Subsection or select a Data Set and After Field.
15. When the Add to Custom Subsection is selected now you can place this question in any of your agencies Custom Subsections using the dropdown.
- See article ePCR Sections on how to create custom subsections.
16. If choosing to add the custom question to a Data Set use the dropdown to select which Data set.
Data Set:
- DEMDataSet - will compare against a state specific Demographics set.
- EMSDatatSet - will compare against the national NEMSIS standard.
17. Once the Data Set is selected you will need to set the After Field by using the dropdown.
- This is where the custom question will appear within the ePCR.
18. From the Values you can choose to create a dropdown field or have a memo field to answer the custom question.
- If Not Values and Pertinent Negatives were selected then you are able to set Default values to those areas.

Default Not values can only be set if Usage is set to Required or Recommend.
19. When enabling the Memo Field you can set the min/max characters allowed to answer, then set a default value.
20. When Dropdown Field is enabled you can create a customized dropdown list to answer the question.
21. To create custom dropdowns a Code and Value is required, set a choice as the default along with enabling the choices to appear as an option.
- Code - This value will be associated to the dropdown value for tracking purposes.
- Value - This is what will appear as an option to answer the question.
- To add or remove dropdown options select the - to remove and the + to add options.
22. To save and create your new custom question select Add.