Continuation portion 2026

1. Click ‘Get Form’ to open the continuation portion in the editor.
2. Begin by entering the Doctor's Name in the designated field. This ensures that all services are correctly attributed.
3. Input the Carrier Case Number and WCB Case Number. These identifiers are crucial for tracking and processing your claim.
4. Fill in the Patient's information, including their Social Security Number, ensuring accuracy for verification purposes.
5. Specify the Dates of Service by selecting the 'From' and 'To' dates using the date picker tool for convenience.
6. Indicate the Place of Service by filling in the relevant details as required.
7. Document the Date of Accident or Injury accurately to support your claim.
8. List all Procedures, Services, or Supplies provided, along with their corresponding CPT/HCPCS codes and any applicable modifiers.
9. Enter Diagnosis Codes as needed to clarify medical conditions related to services rendered.
10. Finally, input Charges, Days or Units, and Zip Code where service was rendered to complete your submission.

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