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Get NY MG-1.1 2014-2024

Injury Patient's Social Security Number INSTRUCTIONS TO ATTENDING DOCTOR: This form must be filed attached to a completed Form MG-1 if requesting optional prior approval for additional treatment(s) or procedure(s) in the same case. A. The undersigned requests additional optional approval under the WCB Medical Treatment Guidelines as indicated below: CARRIER'S/EMPLOYER'S RESPONSE 2. Treatment/Procedure Requested Guideline Reference: (In first box, indicate injury and/or condition: K = Knee, .

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