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Get Ny C-4.0 2015
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How to fill out the NY C-4.0 online
This guide provides clear and supportive instructions on how to complete the NY C-4.0 form online. This form is essential for reporting the initial treatment of a patient involved in a workers' compensation case.
Follow the steps to successfully complete the NY C-4.0 form online.
- Press the 'Get Form' button to access the NY C-4.0 form online and open it for editing.
- Fill in the patient's information, including their name, Social Security number, home phone number, mailing address, and date of injury or onset of illness. Ensure all details are accurate and attached extra pages if necessary.
- Provide employer information such as the company name, phone number, and address where the injury occurred.
- Complete the doctor's information section, including your name, WCB authorization number, federal tax ID, and specialty. Ensure to check the relevant boxes for your occupation.
- Incorporate billing information, including the employer's insurance carrier, carrier address, and the diagnosis code as well as any procedures or services provided.
- Answer all questions related to the patient's history and examination findings, ensuring to specify any other health providers involved in the treatment.
- Provide a clear opinion regarding the medical cause of the injury and detail the proposed treatment and any follow-up appointments. Include any prescribed medications and diagnostic tests needed.
- Review all sections thoroughly for completeness and accuracy to prevent any delays in processing.
- Once finished, save your changes. You may also download, print, or share the completed form as necessary.
Complete the NY C-4.0 form online today for efficient processing of workers’ compensation claims.
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To file a workers' comp claim in New York, start by completing the NY C-4 form, which documents your injury. Next, submit this form along with any required documentation to the Workers' Compensation Board. If you need detailed guidance, US Legal Forms is available to help you navigate the filing process effectively.
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