Patient Forms: Prepare for your Visit
At Musculoskeletal Resources Pain and Injury, we provide easy access to all necessary forms for your upcoming appointment. While you will be supplied with documents in the office, we are happy to provide you with the option to complete some of these forms in advance. By doing so, you can help streamline your visit and ensure our team has all the information needed to deliver the highest quality care. This opportunity will also allow you to fully digest the information so that you become familiar with the process of navigating a personal injury claim. Please take a moment to download, review, and fill out the forms before your appointment. If you have any questions, feel free to contact us for assistance.
Please find the following forms available for your review and download:
- HIPAA Privacy Authorization Form
- HIPAA protects your privacy by keeping your health information confidential and secure, and it gives you rights over your medical records. By completing this form, you provide consent for the practice and providers to contact only your designated contacts.
New York No Fault and Workers’ Compensations Forms
- Workers’ Compensation Claim Form (New York)
- C3 | A C-3 form is used in workers’ compensation cases to file an employee’s claim for benefits after a workplace injury in New York State. It provides details about the injury, how it occurred, and the medical treatment received. This form starts the process of claiming workers’ compensation benefits.
- OC110 | An OC-110A form, known as the “Authorization to Release Medical Records,” is used in New York State workers’ compensation cases. It allows the release of an injured worker’s medical records to relevant parties, such as the insurance company, employer, or legal representatives, to process and review the claim.
- Auto Accident Claim Form (New York No Fault)
- NF2 | An NF2 form is used in New York State by car accident victims to claim no-fault insurance benefits. It helps cover medical expenses and lost wages, regardless of who was at fault.
- AOB | An Assignment of Benefits (AOB) form lets a healthcare provider receive direct payment from a patient’s insurance for services rendered.
We are always expanding our resources. Check back for new forms and resources added to this page in the near future.