Get Ny C-5 2015-2025

Filling out the NY C-5 form online is an essential step for attending ophthalmologists reporting on workers' compensation cases. This guide will provide clear instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the NY C-5 form online

1. Press the ‘Get Form’ button to access the NY C-5 form and open it in your preferred digital editor.
2. Begin by filling in the basic identification details such as the WCB case number, the injured person's full name, and their social security number. Ensure that you type all information accurately.
3. Provide the date and time of the injury, along with the address where the injury occurred. This information is vital for documenting the report correctly.
4. Indicate whether services were provided under the WCB Preferred Provider Organization (PPO) Program by selecting 'Yes' or 'No.'
5. Complete the sections regarding the history of the injury, including how it occurred and any pre-existing ocular conditions. Be thorough in your descriptions to ensure accurate assessment.
6. Detail the nature and extent of the injury, specifying any permanent ocular defects and/or disfigurements. Attach any necessary visual aids, such as diagrams or test results.
7. Document the present condition of the injured eye, including any visual acuity results and whether these conditions are permanent or related to the present injury.
8. List all treatment provided and any future treatments planned. If special services or further testing is required, be sure to include requests for authorization here.
9. Indicate the patient's work status and describe their disability level, specifying if they are totally or partially disabled.
10. Ensure that the form is signed by the attending ophthalmologist, including the federal tax identification number and any necessary credentials.
11. Once all fields are completed, you can save changes, download the filled-out form, print it for physical submission, or share it digitally as needed.

Complete and submit your NY C-5 form online today to ensure a smooth reporting process.