Fortunato & Fortunato ~ Useful Forms

These forms can be filled in on your computer, saved and emailed to your attorney, or printed and brought with you to your next appointment. Please refer to your attorney for more information about which ones you are required to bring with you.

> State of New York Workers' Compensation Board Form (C4)

> State of New York Workers' Compensation Board - Claimant's Record of Medical and Travel Expenses (C-257)

> Authorization For Release of Health Information Pursuant to HIPAA

> State of New York Workers' Compensation Board - Claimant's Authorization to Disclose Workers' Compensation Records (OC110A)

> General Authorization for Use and Disclosure - WORD DOCUMENT | PDF

> Social Security Administration Consent for Release of Information