Mg2 1 2014 form-2025

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70 votes

The document is a continuation form (MG-2.1) for attending doctors to request approval for variances from the Workers' Compensation Board (WCB) Medical Treatment Guidelines. It outlines the necessary information and supporting medical evidence required for each variance request related to specific injuries or conditions. The form includes sections for medical necessity, health provider certification, carrier/employer responses, and claimant requests for review in case of denial.

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Click ‘Get Form’ to open the mg2 1 2014 form in the editor.
Begin by entering the patient's information, including their name, WCB case number, and social security number in the designated fields.
In section A, specify the additional approvals requested by indicating the injury or condition in the first box and referencing the corresponding WCB Medical Treatment Guidelines in subsequent boxes.
Attach any supporting medical documentation required for each request. Ensure that you include dates of service and previously denied variance requests if applicable.
Complete the Health Provider's Certification section by signing and dating it. Make sure to confirm that all statements are true and correct.
Review all entries for accuracy before submitting your completed form through our platform for processing.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (50 Votes)
2014	4.3 Satisfied (70 Votes)
2013	4 Satisfied (33 Votes)

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