Get Ny Ehs-707 2019-2026

The NY EHS-707 form is a crucial document used for requesting medical examinations within various state agencies. This guide will provide you with clear and comprehensive steps to successfully complete the form online.

Follow the steps to accurately fill out the NY EHS-707 form.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the 'Person requesting examination' section. Here, you need to print your name, provide your signature, title, date of request, and contact information including phone and fax numbers.
3. Next, enter the agency name and address. Be sure to also include your agency code and division for identification purposes.
4. In the 'Payment Coordinator' section, list the name and address of the payment coordinator, along with their phone number.
5. Complete the contact information for the person who will schedule the appointment by providing their name and phone number.
6. Fill in the information concerning the employee for whom the examination is requested. This includes their name, social security number, date of birth, street address, city, state, agency, zip code, and title.
7. Indicate the legal authority for the request by selecting the appropriate option such as Involuntary Leave, Reinstatement, ADA, or others specified in the form. Ensure to attach an explanation that includes an official job description, task assignments, and any reasonable accommodations.
8. Once you have completed filling out the form, review all entries to ensure accuracy. You can then save your changes, download a copy, print it, or share it as needed.

Complete your documents online today for a streamlined process.