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
Chair