Ancillary Medical Report (EC-4 AMR)
Web Submission Process Tutorial
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
- Access the EC-4AMR form on the Board's web site.-
- 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)
- Review all sections to be sure the information is accurate.
- Update section C. Billing information.
- Provide the information about who provided the services and the name and specialty of the Board Authorized Health Care Provider.
- Scroll to the bottom of the form and select the Save Data button.
- 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.
- Select the paper clip icon or the attachment tab on the left of side of the page.
- Select the Add icon.
- 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.
- Select Submit Form