Form Instructions

Submit Forms

If you would like to see the full form before submitting, you can use the print preview function in your browser.
Select the Submit button at the bottom of the form.
The data that you entered will be validated.

If you receive a message pop-up OR a message appears at the top of the form in red, the form has NOT been submitted.
Select the appropriate tab and correct the data then re-submit the form.

After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. It should be saved for your records and used to send copies of the form and any attachments to required parties. DO NOT MAIL THIS FORM TO THE BOARD.
You may select the back button on your browser to go back to the fillable form. However, the form will still have the data from your previous submission.

Load Previously Saved Data Load Previously Saved Data

Select the button next to Load Previously Saved Data at the top of the page just above the tabs.
Choose 1 XML file (file will have an .xml extension) that you previously saved to your system.
Once a file is selected, the form will be flooded with data.
Review all sections to be sure the information is accurate.

Save Data

Prior to submitting the form, you should save the data. This saved data can be loaded the next time you need to submit another form for the patient. This alleviates the need to re-enter the same information each time you submit a form.
You will need to decide where to save these files. If all forms will be submitted from the same computer, you may choose to save them to the computer's hard drive; however, if the forms will be generated from multiple computers that are on a network, you may want to save them to a shared network drive.
Select the Save Data button at the bottom of the form.
The name of the file will default to <FormID>_data.xml (i.e. EC-4NARR_data.xml). We recommend that you change the name of the file to include the patient's name and the date of form submission. (i.e. DoeJohn_3-1-17.xml)
You will use this xml file to load the data into subsequent submissions of the form.
Depending on your browser settings, the file may automatically download to a predetermined folder such as 'downloads'. If you need to change the location for where the file is saved, the following links provide information for saving a file to a specific folder.

Select File(s) to Attach Select File(s) to Attach

Select the button next to Select File(s) to Attach at the lower left side of the form.
Choose 1 or more files - to select more than 1 file, use the Ctrl button on your keyboard.
Acceptable file attachments types are:

PDF files (.pdf file extension)
Text files (.txt file extension)
MS Word files (.doc file extension)
Rich Text files (.rtf file extension)
Tiff files preferably with a resolution of 200 dpi (.tif or .tiff file extension)
JPEG files (.jpg file extension)
GIF files (.gif file extension)
BMP files (.bmp file extension)

Any attachments will not be displayed or attached to the non-editable PDF version of the form that is returned to you upon successful submission. You must keep these attachments with your records and mail them to parties of interest along with the form.

Workers’ Compensation Board Home