Get Me Form Wcb-220 2018-2025

The ME Form WCB-220 is essential for the release of medical and health care information necessary for workers' compensation claims in Maine. This guide provides step-by-step instructions to help users complete this form online effectively.

Follow the steps to fill out the ME Form WCB-220 online.

1. Press the ‘Get Form’ button to access the form and open it in your editing tool.
2. Enter your full name in the designated field at the top of the form.
3. Provide the last four digits of your Social Security number in the appropriate box, labeled SSN (last 4 digits).
4. Fill in your date of birth by selecting the correct date from the date picker.
5. Indicate the date of your injury or illness by either entering the date manually or selecting it from the date picker.
6. In the section for the employer, insurer, or employee representative notice, confirm your understanding of the importance of using the Board’s forms for releasing protected medical information.
7. Specify the body part(s) and/or condition(s) related to your claim in the provided space.
8. Fill in the start date for the release of your records, which should be the earliest date related to your diagnosis, treatment, and care.
9. Review the notice regarding your rights and the voluntary nature of the form completion. Make sure you understand the implications of not completing the form.
10. Authorize the release of your medical records by signing in the Employee or Authorized Representative Signature field.
11. Include the date of your signature to finalize the authorization.
12. Choose the desired format for receiving your information by circling your preference: electronically, by fax, or by mail.
13. Finally, check all filled information for accuracy, then save your changes. You may also download, print, or share the completed form as needed.

Complete your forms online today for a smooth workers' compensation claim process.