This paper presents a methodology for separating handwritten foreground pixels, from background pixels, in carbon copied medical forms. Comparisons between prior and proposed techniques are illustrated. This study involves the analysis of the New York State (NYS) Department of Health (DoH) Pre-Hospital Care Report (PCR) [Western Regional Emergency Medical Services, Bureau of Emergency Medical Services, New York State (NYS) Department of Health (DoH), Prehospital Care Report v4.] which is a standard form used in New York by all Basic and Advanced Life Support pre-hospital health care professionals to document patient status in the emergency environment. The forms suffer from extreme carbon mesh noise, varying handwriting pressure sensitivity issues, and smudging which are further complicated by the writing environment. Extraction of handwriting from these medical forms is a vital step in automating emergency medical health surveillance systems.
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