We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
  • US Legal Forms
  • New York Physician's Report of Impartial Specialist Examination or...

New York Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review

Category:
Workers Compensation - Official
State:
New York
Control #:
NY-IS-4-WC
Format:
PDF
Instant download
Buy now
This website is not affiliated with any governmental entity
Public form

Description

Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review
The New York Physician's Report of Impartial Specialist Examination (PREP) or Impartial Specialist Record Review (IPR) is a document used by the New York State Department of Health to evaluate medical records and provide an impartial medical opinion regarding a patient's condition or disability. The PREP or IPR is requested by the Department of Health when a patient's medical record is incomplete or unclear. The PREP or IPR is conducted by a physician with specialized knowledge and expertise, and includes a review of all relevant medical records, an independent medical examination, and a detailed written report. The PREP or IPR is used to help the Department of Health determine if a patient is eligible for medical benefits, or if further medical treatment is necessary. The two different types of New York Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review are: 1) PREP — Physician’s Report of Impartial Specialist Examination 2) IPR — Impartial Specialist Record Review

The New York Physician's Report of Impartial Specialist Examination (PREP) or Impartial Specialist Record Review (IPR) is a document used by the New York State Department of Health to evaluate medical records and provide an impartial medical opinion regarding a patient's condition or disability. The PREP or IPR is requested by the Department of Health when a patient's medical record is incomplete or unclear. The PREP or IPR is conducted by a physician with specialized knowledge and expertise, and includes a review of all relevant medical records, an independent medical examination, and a detailed written report. The PREP or IPR is used to help the Department of Health determine if a patient is eligible for medical benefits, or if further medical treatment is necessary. The two different types of New York Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review are: 1) PREP — Physician’s Report of Impartial Specialist Examination 2) IPR — Impartial Specialist Record Review

Related forms

form-preview
Alternative Complaint for an Accounting which includes Egregious Acts

Alternative Complaint for an Accounting which includes Egregious Acts

View this form
form-preview
Demand for Discovery in an Action for an Accounting

Demand for Discovery in an Action for an Accounting

View this form
form-preview
Answer to Alternate Complaint

Answer to Alternate Complaint

View this form
form-preview
Court Order Resolving an Action for Accounting

Court Order Resolving an Action for Accounting

View this form
form-preview
Form of Accounting Index

Form of Accounting Index

View this form

Viewed forms

form-preview
Audit of Lessee's Books and Records

Audit of Lessee's Books and Records

View this form
form-preview
Notice of Termination Due to Work Rules Vi...

Notice of Termination Due to Work Rules Violation

View this form
form-preview
Amended and Restated Notice of Lending

Amended and Restated Notice of Lending

View this form
form-preview
Order to Show Cause and Temporary Restrain...

Order to Show Cause and Temporary Restraining Order - Rents, Issues, and Profits - Receivership

View this form
form-preview
Water Usage Agreement

Water Usage Agreement

View this form
form-preview
Certificate of Assumed Name

Certificate of Assumed Name

View this form
form-preview
Waiver Special Meeting of Shareholders

Waiver Special Meeting of Shareholders

View this form
Application for Admissions to Roster of Me...

Application for Admissions to Roster of Mediators

View this form
form-preview
Stipulation for Compromise Settlement Purs...

Stipulation for Compromise Settlement Pursuant to 28 U.S.C. Section 2677

View this form
form-preview
Certificate of Merger of PLC Properties LLC

Certificate of Merger of PLC Properties LLC

View this form

How to fill out New York Physician's Report Of Impartial Specialist Examination Or Impartial Specialist Record Review?

US Legal Forms is the most easy and profitable way to locate suitable formal templates. It’s the most extensive web-based library of business and individual legal paperwork drafted and checked by legal professionals. Here, you can find printable and fillable blanks that comply with national and local regulations - just like your New York Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review.

Getting your template requires just a couple of simple steps. Users that already have an account with a valid subscription only need to log in to the website and download the form on their device. Afterwards, they can find it in their profile in the My Forms tab.

And here’s how you can get a properly drafted New York Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review if you are using US Legal Forms for the first time:

  1. Look at the form description or preview the document to make certain you’ve found the one corresponding to your requirements, or find another one utilizing the search tab above.
  2. Click Buy now when you’re certain about its compatibility with all the requirements, and choose the subscription plan you prefer most.
  3. Register for an account with our service, sign in, and purchase your subscription using PayPal or you credit card.
  4. Select the preferred file format for your New York Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review and save it on your device with the appropriate button.

Once you save a template, you can reaccess it at any time - just find it in your profile, re-download it for printing and manual completion or upload it to an online editor to fill it out and sign more effectively.

Benefit from US Legal Forms, your reputable assistant in obtaining the corresponding formal documentation. Try it out!

Form popularity

FAQ

James A. Tacci, MD, JD, MPH (FACOEM, FACPM), is the Medical Director of the NYS Workers' Compensation Board.

If you filed a claim and were assigned a number, you can call (646)264-3000 for information about your claim. If you are a U.S. Department of Labor employee, please call (816)502-0301 for claim status information.

Customer Service Toll-Free Number: (877) 632-4996.

SI-12 (7/09) Affidavit Certifying That Compensation Has Been Secured. Employers with Board-approved self-insurance for workers' compensation. Filed with the government agency issuing a permit, license or contract. The SI-12 must be completed by the Board's Self-Insurance Office and approved by the Board's Secretary.

If you filed a claim and were assigned a number, you can call (646)264-3000 for information about your claim. If you are a U.S. Department of Labor employee, please call (816)502-0301 for claim status information.

All inquiries related to EFT payment effective date, claim/benefit explanations, and discontinuation of payments should be directed to the Law Department at workerscompensation@law.nyc.gov or by phone at (718)724-5500.

If you need help finding a health care provider or would like additional information, please contact the Board's Medical Director's Office at (800) 781-2362, option 2.

More info

The IS must complete a written report following the exam or record review on the Form IS-4. All sections of the form are required to be completed.Report Details: You typically receive the medical records 30 days in advance. Our experienced medical experts competently provide a broad diversity of evaluation services addressing your medicolegal needs. Search our Independent Medical Examinations (I. M.E.) expert witnesses. A. Treatment Records. You should clearly list and accurately describe all of the medical records and other documents you reviewed before preparing your IME report. As such, it is incumbent upon the physician to retain comprehensive records of the exam. We pledge that we will be both thorough and impartial.

Trusted and secure by over 3 million people of the world’s leading companies

New York Physician's Report of Impartial Specialist Examination or Impartial Specialist Record Review
Buy now