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This form is used for a workers' compensation, volunteer firefighters' or volunteer ambulance workers' benefit case as follows: To request approval to vary the treatment of the claimant identified on this form from the relevant Medical Treatment Guidelines.
List of ALL Common Workers’ Compensation Board Forms. Workers’ Compensation Forms (On The Job Injuries) Injured Workers. Volunteer Firefighters and Volunteer Ambulance Workers. Employers. Insurers, Self-Insured Employers and Third-Party Administrators. Health Care Providers. Attorneys and Licensed Representatives. Self-Insurance. Homeowners.
The MTGs are the standard of care for treating individuals with work-related injuries and illnesses in New York State and are based on the best available medical evidence and the consensus of experienced medical professionals.
Download Fillable Form Mg-2 In Pdf - The Latest Version Applicable For 2024. Fill Out The Attending Doctor's Request For Approval Of Variance And Carrier's Response - New York Online And Print It Out For Free.
Medical providers should submit their Attending Doctor's Request for Authorization (C-4Auth) requests and Medical Treatment Guideline (MTG) Variance Requests, forms MG-2 and MG-2.1, to NYSIF business offices' MTG teams.
This form is used for a workers' compensation, volunteer firefighters' or volunteer ambulance workers' benefit case as follows: To request approval to vary the treatment of the claimant identified on this form from the relevant Medical Treatment Guidelines.
Requests (previously done using the Attending Doctor's Request for Approval of Variance and Carrier's response (Form MG-2)). MTG Special Services Requests, which only include the 12-MTG related requests on the Attending Doctor's Request for Authorization Carrier's Response (Form C-4 AUTH) .
