---

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,

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.

Review all sections to be sure the information is accurate.