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Workers' Compensation Board

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

Submitting an EC-4AMR Form For a Patient

Filling out the Form

Select the "Load previously saved EC-4AMR data" button near the top of the form,
Load previously saved EC-4AMR data button
and then select the data file that you previously created for the doctor (doctorName.xml), or for the doctor and carrier (carrierName.xml),or complete section B. Doctor's Information and the insurance carrier's information in section C. Billing Information.

On the form, complete section A. Patient's Information.

Patient's Information in Section A of EC4AMR

Review all sections to be sure the information is accurate.

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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