Form C-27 - Nys Workers Compensation Board Page 2

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HIPAA NOTICE - In order to adjudicate a workers' compensation claim, WCL13-a(4)(a) and 12
NYCRR 325-1.3 require health care providers to regularly file medical reports of treatment with
the Board and the carrier or employer. Pursuant to 45 CFR 164.512 these legally required
medical reports are exempt from HIPAA's restrictions on disclosure of health information.
C-27 Reverse (1-11)

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