In order to reopen a claim more than seven years after an accident, this form must be filed immediately with the chair of the Workers' Compensation Board, together with the attending doctor's report ( form C-27 ) if required, at the district office...

After you have read the dental claim form instructions (below) you are ready to fill out the dental claim form as needed.

This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules...

This form is for payroll secretaries.

Fill out and have this affidavit notarized to cover unmarried children over age 26 who cannot support themselves because of a mental illness, developmental disability, mental retardation or physical handicap under the UFT Welfare Fund Benefit Plan....

Include all original pharmacy receipts with prescription detail clearly noted which must include the name, strength, quantity and price. Please attach to this form. Receipts must be mailed within 90 days from date of service. Reimbursement will be in...

For GHI-CBP in-service members only, the Welfare Fund will reimburse up to $100/year of the deductible for the purchase or rental of durable medical equipment, with this form and an original Explanation of Benefits (EOB) from GHI.

Read this notice of privacy practices to understand how protected health information about you may be used and disclosed and how you can get access to this information.

You can choose a personal representative(s) to share your health information with by filling out this form.