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Form C-4 Doctor's Initial Report - New York
What Is Form C-4?
This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-4?
A: Form C-4 is the Doctor's Initial Report in the state of New York.
Q: Who needs to fill out Form C-4?
A: Form C-4 needs to be filled out by the treating physician.
Q: What is the purpose of Form C-4?
A: The purpose of Form C-4 is to report the initial examination findings and diagnosis of an injured worker.
Q: What information is required on Form C-4?
A: Form C-4 requires information about the injured worker, their injury, medical history, physical examination findings, and diagnosis.
Q: When should Form C-4 be submitted?
A: Form C-4 should be submitted within 48 hours of the initial examination or as soon as possible after the examination.
Q: What happens after Form C-4 is submitted?
A: After Form C-4 is submitted, it will be reviewed by the Workers' Compensation Board and may be used as evidence in the worker's compensation case.
Form Details:
- Released on August 1, 2020;
- The latest edition provided by the New York State Workers' Compensation Board;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form C-4 by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
Download Form C-4 Doctor's Initial Report - New York
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