C4 Forms - What Are They And When Do You Use Them?

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A C4 Form is a workers' compensation board form titled "Attending Doctor's Report," that requests information about claimaint/claim identification, claim parties of interest, injury history, diagnosis, treatment, disability, causal relation of emergency to disability, and degree of impairment. The form is to be filed by the doctor within 15 days of the introductory treatment, with supplementary reports while treatment, and a final record at the completion of treatment. Once the introductory form is filed, subsequent visits should be billed out within 45 days of the visit.

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C4 forms are required when billing for services connected to workers' compensation, or when a patient was injured on the job. Many convention administration systems come with these forms as a proper assurance form listed in the assurance form menu of the program. That is the easiest way to submit them. You truly print the claim on white paper, and the program not only prints up the charges and other information, but truly creates the form too.
If your convention administration theory does not have the form available, you can ordinarily get a blank form online through your state's website.

Once you have a blank form, you can either type the information in, or if your software has the capabilities, you can program your software to fill in the boxes on the form. In any case, you will need to submit a copy directly to the workers' compensation carrier, and the state workers' compensation board as well.

It is highly prominent that all boxes on the C4 form are completed accurately. A copy of the form is submitted to the state workers' compensation board and those forms are ordinarily scanned into a computer system. When or if a case goes to a hearing, the information on these forms is used. If the information is not completed, or is not accurate, it can adversely work on the outcome of the hearing. For example, if the doctor does not complete the box indicating the patient is disabled, and the patient is truly disabled, the employers lawyers can argue that the disability has not been established. So even leaving a field blank can be detrimental.

The forms are fairly easy to fill out and are pretty self explanatory.

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