New York State Workers' Compensation Board Forms

This Form is used for notifying the plaintiff to make arrangements for tests and diagnostic exams through a network provider in New York.

This form is used for notifying a claimant in New York who needs to schedule diagnostic tests and examinations through a network provider. This document is available in Bengali.

This form is used for obtaining authorization under the Health Insurance Portability and Accountability Act (HIPAA) for volunteers involved with the World Trade Center in New York.

This document authorizes the use and disclosure of health information for volunteers at the World Trade Center site under the Health Insurance Portability and Accountability Act (HIPAA). It is available in Haitian Creole for residents of New York.

This Form is used for obtaining authorization for the disclosure of protected health information under the Health Insurance Portability and Accountability Act (HIPAA) for World Trade Center volunteers in New York who speak Italian.

This document is used for obtaining authorization from World Trade Center volunteers in New York to access and disclosure their medical insurance information under the Health Insurance Portability and Accountability Act (HIPAA).

This Form is used for obtaining authorization under the Health Insurance Portability and Accountability Act (HIPAA) for World Trade Center volunteers in New York.

This Form is used for employees in New York to file a claim related to a work-related injury or illness. It helps employees to seek compensation and benefits for their injuries.

This form is used for the limited release of health information in accordance with HIPAA regulations in the state of New York, specifically for individuals who speak Italian.

This document is a form used in New York to authorize the limited release of health information in accordance with HIPAA regulations. It is available in Haitian Creole language.

This form is used for objecting to a payment bill for treatment provided in New York.

This type of document, Form C-25 Application for Reopening of Claim, is used in New York to apply for the reopening of a claim that is more than seven years old. The form is available in Haitian Creole language.

This Form is used for filing a complaint regarding language access issues in New York.

This form is used for filing a language access complaint in New York, specifically for complaints in French.