Modify Your Blank C4.x Forms

Updated 3/15/2009

There are a number of fields on the new C4s that you can hard code to a constant so that you don't have to re-enter the same information on every form you make for every patient. For example, you WCB Rating Code goes into Field B3 of form C-4.2. You will have to manually type that code every time you fill out this form, or you can hard code it as a constant. This is just one example of many field that have been indentified as possible constant fields.

Form C-4.0

• Field C2, WCB Authorization #
• Field C3, Check boxes
• Field C4, WCB Rating Code
• Field C10, SSN or EIN checkbox
• Signature area, "I provided the services listed above" checkbox
• Signature line, Your signature (Ask us how)
• Signature line, Specialty.

Form C-4.2

• Field B2, WCB Authorization #
• Field B3, WCB Rating Code
• Field B9, SSN or EIN checkbox
• Signature area, "I provided the services listed above" checkbox
• Signature line, Your signature (Ask us how)
• Signature line, Specialty.

From C-4.3

• Field B2, WCB Authorization #
• Field B3, WCB Rating Code
• Field B9, SSN or EIN checkbox
• Signature line, Your signature (Ask us how)
• Signature line, Specialty.

If you do not know how to modify your forms in Eclipse or don't have time to do it yourself, give us a call. We have a special service where we'll modify all three of your primary C4 forms, C4.0, C4.2, & C4.3 for you and get you ready to implement the new billing forms. For a small additional charge, we'll digitize your signature and place it on the forms for you so they are self signing as your print them. Give us a call to discuss how we can help you make your practice more efficient, 516.816.5678!