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Submitting an EC-4 AMR Form For a Patient

Submitting Additional EC-4AMR Forms

Upon successful submission of your EC-4 AMR, you will receive a confirmation page along with a non-editable version of the form you submitted. If you would like to submit another form for a different patient, select the "Submit another EC-4 AMR" on this confirmation page and a new form will open in your web browser.

Submitting Subsequent EC-4 AMR Forms for the same patient

1. Access the EC-4AMR form on the Board's web site.-
2. Select the "Load previously saved EC-4 AMR data" button and select the data file you saved when you submitted the previous EC-4 AMR form (the one with the .xml file extension)
   
3. Review all sections to be sure the information is accurate.
4. Update section C. Billing information.
5. Provide the information about who provided the services and the name and specialty of the Board Authorized Health Care Provider.
6. Scroll to the bottom of the form and select the Save Data button.
7. Save the file in the patient's folder include in the name the date the form is being submitted. (i.e. patientName12-31-08.xml). This file will have an .xml file extension.
8. Select the paper clip icon or the attachment tab on the left of side of the page.
9. Select the Add icon.
10. Select the Report for Services file that should accompany this form and then select the "Open" button. The file(s) should appear in the attachment box below the form.
11. Select Submit Form