Get Medical Director's Office - Riverview Center

Completing the Medical Director's Office - Riverview Center application is essential for health providers seeking authorization under the Workers' Compensation Law. This guide provides clear, step-by-step instructions to assist users in accurately filling out the form online.

Follow the steps to successfully complete your application.

1. Click 'Get Form' button to obtain the form and open it in your preferred editor.
2. Review the form's initial section, which requires you to check your professional title. Select one option from the following: Physician, Podiatrist, Chiropractor, or Psychologist.
3. Indicate the purpose of your application by checking one or more of the following options: Initial Authorization, Reinstatement, or Change in Rating (for Physicians only).
4. Provide your full name, date of birth, and home address in the designated fields. Ensure all information is typed or printed clearly.
5. Enter your New York State Professional License number, the date it was granted, and your NPI number in the corresponding sections.
6. List all office addresses where you provide care in New York State. Include your principal office and any additional locations. Verify that you have valid registration certificates for each address.
7. Fill in your major hospital affiliations, detailing the hospitals where you have privileges, including the clinical services provided and positions held.
8. Provide information about your current professional society memberships and any board certifications. Ensure you specify if you are seeking authorization to conduct Independent Medical Examinations.
9. Complete fields related to your education, including the name of the professional school, degree, and year of graduation. Also, include any postgraduate studies.
10. Answer all yes/no questions regarding prior authorizations, professional license issues, and ability to accommodate claimants who speak languages other than English.
11. Sign and date the application, acknowledging that you understand the conditions for authorization. Review all entries for accuracy and clarity before submission.
12. Remember to save your changes once completed. You may also download, print, or share your form as necessary.

Complete your application online today to ensure timely processing.