PRIVATE PHYSICIAN PROCESS FORMS
Updated: April 16, 2018
- Private Physician Process Instructions
- Private Physician Packet: NYC Site (Claim Form Appendix C)
- Private Physician Packet: Pentagon and Shanksville, PA Sites (Claim Form Appendix D)
- Treating Physician Information Form
- Authorization for Release of Medical Records: Personal Injury Claimants
- Authorization for Release of Medical Records: Claims for Deceased Individuals
- Cover Sheet for Returning Forms
WTC HEALTH PROGRAM GUIDANCE
The WTC Health Program has published the following materials related to the VCF Private Physician process. Claimants are strongly encouraged to review these materials before completing the Private Physician forms.
- Diagnostic Essentials for Physical Health Conditions: These guidelines outline the specific documentation that is required in order to verify a condition for compensation from the VCF.
- WTC Health Program Time Intervals for New Onset Aerodigestive Disorders (Updated: August 30, 2017)
- Minimum Latency and Types or Categories of Cancer (November 7, 2014)
Click here to visit the WTC Health Program website.
- If you enter information into one of these files and save it to your computer, please save the file with a new name. Please also remember that the file contains personal information. You may not want to save the file on a public or shared computer where others have access.
- We can process your claim faster if you gather all the completed forms and relevant documents and upload them to your online claim at the same time or return them in one mailing. When uploading any portion of the Private Physician forms to the online claim, please select from the Eligibility document types and choose "Private Physician Forms" as the applicable document type.