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Workers' Compensation Board

Give yourself extra time to arrive at our Garden City office Monday due to traffic changes for the presidential debate at nearby Hofstra University. For traffic restrictions, http://bit.ly/2dpaZST.

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Ancillary Medical Report (EC-4 AMR)
Web Submission Process Tutorial


Submitting an EC-4 AMR Form For a Patient

Printing the Form

Select the Print button to print the form
Print button

You will need to open the attachment and print it.
Open Attachment Icon

Mail required copies to the insurance carrier, attorney, licensed representative and the patient.

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Filling out the Form | Add Billing Information | Who Provided Services | Saving Patient Data | Adding Attachments | Submitting the Form | Successful Submissions | Saving the PDF | Printing the PDF | Submitting Additional Forms