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10834

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This document is an application form for individuals who are visually impaired and seeking services from the Commission for the Blind in New York. The form is provided in French.

This Form is used for the National Electronic Interstate Compact Enterprise (NEICE) in New York to establish a confidentiality non-disclosure agreement.

This Form is used to notify individuals in New York (Spanish) that they may be responsible for medical costs if their compensation claim is disallowed or if an agreement under WCL 32 is approved.

This form is used in New York to notify individuals that they may be responsible for medical costs if their compensation claim is disallowed or if they fail to prosecute. It also applies if an agreement pursuant to WCL 32 is approved.

This form is used for the limited release of health information in compliance with HIPAA regulations in New York. It allows individuals to authorize the disclosure of specific medical records to a designated party.

This form is used for doctors in New York to report on the patient's Maximum Medical Improvement (MMI) and Permanent Partial Impairment (PPI).

This form is used for revoking the election of an incorporated religious, charitable, educational, or U.S. war veterans organization to bring executive officers under the coverage of the New York Workers' Compensation Law in New York.

This form is used for notifying an incorporated religious, charitable, educational, or U.S. war veterans organization in New York about their election to bring executive officers under the coverage of the New York Workers' Compensation Law.

This Form is used for injured workers in New York who need assistance. It is available in Polish.

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