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db 450 2 04
db 450 2 04

Fillable Printing T:\AAOSHARE\FINLFORM\DB450.FRP - wcb ny

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Pursuant to 45 CFR 164. 512 these legally required medical reports are exempt from HIPAA s restrictions on disclosure of health information. DB-450 Reverse 2-04 THE WORKERS COMPENSATION BOARD EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION.. IF YOU HAVE ANY QUESTIONS ABOUT CLAIMING DISABILITY BENEFITS CONTACT THE NEAREST OFFICE OF THE NYS WORKERS COMPENSATION BOARD OR WRITE TO WORKERS...
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