EMPLOYEE CLAIM C-3


C-3.3 (12-09) www.wcb.ny.gov Limited Release of Health Information (HIPAA) State of New York -Workers' Compensation Board C-3.3 WCB Case No. (if you know it):_____ To Claimant: If you received treatment for a previous injury to the same body part or for an illness similar to the one described in your current Claim, fill out this form.

  • File type: PDF
  • File size: n/a
  • File name: c3.pdf
  • Source: www.wcb.ny.gov

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