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ATTENDING DOCTOR'S REQUEST FOR APPROVAL OF MG-2

State of New York - Workers' Compensation Board ... NYS Workers' Compensation Board, Centralized Mailing, PO Box 5205, Binghamton, NY 13902-5205 ... This form must be signed by the Treating Medical Provider and must contain his/her authorization certificate number and code letters. If the patient is .

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  York, Certificate, Request, Board, Compensation, Worker, Approval, Compensation board, Request for approval of

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