Get 2 Doctor 's Progress Report Use This Form To Report Continuing Services - Wcb Ny

This guide provides clear instructions on how to accurately complete the 2 Doctor's Progress Report Use This Form To Report Continuing Services online. Following these steps will ensure that necessary information is submitted to facilitate timely treatment and benefit payments.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the report form and open it in your chosen editing tool.
2. Enter the date(s) of examination in the appropriate field. If you have the WCB case number and carrier case number, include them here.
3. Provide the patient's information, including their name, date of injury or illness, address, social security number, and account number. Ensure all fields are filled completely.
4. Input your own information, which includes your name, WCB authorization number, tax ID number, billing group name, office address, and contact numbers.
5. Complete the billing information section by entering the employer's insurance carrier name, carrier code, and insurance carrier's address.
6. Document the diagnosis and the nature of the disease or injury, entering the appropriate ICD10 code and descriptor in the designated fields.
7. In the examination and treatment section, describe any diagnostic tests rendered, changes from the most recent examination, and any required treatments.
8. Fill in the patient's return-to-work information, including current work status, any restrictions, and details about necessary follow-ups.
9. Sign the form under penalty of perjury, ensuring that all necessary fields are completed, including your certification number and NPI number.
10. Review the completed form for accuracy, then save your changes. You can download, print, or share the completed document as required.

Complete your forms online today to ensure timely processing of your reports!