New york ps4 form 2026

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The document is a report form for psychologists to file regarding treatment and evaluation of injured workers under the New York Workers' Compensation Board. It outlines the necessary information to be provided, including patient details, injury description, treatment history, and billing information. The report must be submitted within specified timeframes (48 hours, 15 days, and 90 days) and includes instructions for obtaining authorization for special services. It emphasizes that medical bills should not be paid by the injured worker if their claim is approved.

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Click ‘Get Form’ to open the New York PS4 form in the editor.
Begin by entering the injured person's details, including their first name, middle initial, last name, and social security number. Ensure all information is typed clearly.
Fill in the date of injury and time, along with the address where the injury occurred. This section is crucial for accurate record-keeping.
Indicate whether services were provided under the WCB Preferred Provider Organization (PPO) program by selecting 'Yes' or 'No'.
Complete sections regarding the patient's condition and treatment plan. Specify if this report is for evaluation only, treatment only, or both.
Provide additional information as required in items 6 through 18, ensuring that all fields are filled out accurately to avoid delays.
Finally, review all entries for accuracy before signing and submitting your report through our platform.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (62 Votes)

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