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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

Submitting the Form

Select Submit Form
Submit Form Button

There are two separate validations done on your form. The first is done before the form is sent to the Board's web server. This checks for required information and that data entered is formatted correctly. If an error is found, you will need to fix it before your form will be accepted by the Workers' Compensation Board. Once all required fields have been completed, the health care provider will be required to attest to the information on the form.

Please wait while your form and attachment is submitted to the Board. Depending upon the size of the attachment and the type of internet connection you have, this may take a minute.

After the form is received by the Board's web server, your form will be checked a second time to confirm a report for services was attached and the doctor's WCB Authorization Number and CPT codes are valid.

If there is an error, the Board will reject your form and will return the form to your web browser so you can correct the errors and resubmit it. The error(s) will be identified at the top of the form.

Example of error messages at top of form.
error messages

After correcting any error's you should re-save the patient's data file so that it is accurate and then select the Submit Form button.

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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