C-4.3. Use this form: 1. When rendering an opinion on MMI and/or permanent partial impairment; or 2. In response to a request by the Workers' Compensation Board to render a decision on MMI and/or permanent partial impairment.

To report permanent impairment use Form C-4.3. Use this form only if attaching a detailed narrative report. See Attachment Requirements for topics that must be addressed in the narrative attachment.

Use this form when a patient has reached Maximum Medical Improvement and to render an opinion on permanent impairment, if any. (To report the first time you treated the patient, use Form C-4. For continuing treatment, use Form C-4.2.)

2022年7月1日 · The Doctor's Report of MMI/Permanent Impairment (Form C-4.3) is used (1) When rendering an opinion on MMI and/or permanent impairment; or (2) In response to a request by the Workers' Compensation Board to render a decision on MMI and/or permanent impairment. It can be submitted by a Physician, Chiropractor, Podiatrist, Psychologist, Nurse ...

2012年5月5日 · Form C-4.3, created by the Workers’ Compensation Board in January 2012, represents somewhat drastic changes in the way that physicians document permanent impairments in New York State Workers’ Compensation claims.

2024年9月17日 · For workers' claims in New York that result in the permanent impairment of a patient, the C4.3 form, or Doctor's Report of MMI/Permanent Impairment form is required. This form is built into your DrChrono account and is easily accessible through the …

Use this form: 1. When rendering an opinion on MMI and/or permanent impairment; or 2. In response to a request by the Workers' Compensation Board to render a decision on MMI and/or permanent impairment.

When a claimant’s treating physician believes that the claimant has reached Maximum Medical Improvement and/or has a permanent impairment, he or she will complete Form C-4.3 to render an opinion regarding the level of the claimant’s permanent impairment.

Doctor's Report of MMI/Permanent Impairment (Form C-4.3) is available for web submission. This form requires a User ID and Password. If you do not have a user ID and Password visit the How to Register page to learn how to apply for one.