Governor David A. Paterson
Subject No. 046-330
EC-4.2, Doctor's Progress Report, Now Available in Adobe Format
Date: July 1, 2009
Form EC-4.2 is the on-line, electronically-filed version of Form C-4.2, Doctor's Progress Report. As part of the Board's ongoing effort to facilitate web submission of reports, on June 11, 2009, Form EC-4.2 was converted from an HTML to an ADOBE format.
New Features of Adobe Format
- Patient data can be saved and used to submit progress reports for follow-up visits. This will significantly reduce the amount of time it will take to complete subsequent progress reports for the same patient since the saved data can be used to pre-fill the form.
- Incomplete forms can be saved locally then completed and submitted through the Board's web site at a later time.
- Template files with standard information (doctor, patient, carrier) can be saved and used as a basis for web submission of future reports.
- The health care provider may attach additional notes to submit with the form, if necessary. These attachment file types are accepted for web submission:
- Text files (.txt file extension)
- MS Word files (.doc file extension)
- Rich Text files (.rtf file extension)
- Tiff files preferably with a resolution of 200 dpi (.tif or .tiff file extension)
- JPEG files (.jpg file extension)
- GIF files (.gif file extension)
- BMP files (.bmp file extension)
- PDF files (.pdf file extension)
Web Submission Requirements
- The health care provider must be authorized by the NYS Workers' Compensation Board. To become authorized, a health care provider should complete and submit Form MR/IME-1, Health Providers Application for Authorization Under the Workers' Compensation Law.
- If the health care provider does not already have a user ID and password to submit claim forms from the Board's web site, he/she must register and a user ID and password will be assigned to them. This process may take up to a week.
- Adobe Reader® 9 is required to support the additional functionality in this form.
The latest version of Adobe Reader® is available as a free download from Adobe's web site.
- Upon successful submission, the health care provider will be provided with a printable PDF version of the form to keep for their records and to be used to send required copies of Form EC-4.2 and any attachments to the insurance carrier and to the patient's attorney or licensed representative if he/she has one, or to the patient if unrepresented. The form should not be mailed to the Board.
I encourage all health providers to take advantage of the benefits of electronic submission of medical reports, through either web submission or an XML submission partner.
Zachary S. Weiss