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Workers' Compensation Board

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

Submitting an EC-4 AMR Form For a Patient

Indicate Who Provided the Services

If the services were provided by someone other than the Board Authorized Health Care Provider select " I actively supervised the health care provider named below who provided these services." and complete the information for the doctor who provided the services.
Supervised health care provider that provided services

Otherwise select "I provided the services listed above." and make sure the Board Authorized Health Care Provider section is complete.
Name and Specialty of Board Authorized Health Care Provider

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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