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Description of form nf 3
PATIENT WAS DISABLED UNABLE TO WORK FROM 13. IF STILL DISABLED THE PATIENT SHOULD BE ABLE TO RETURN TO WORK ON THROUGH CONTINUE ON PAGE 2 NYS FORM NF-3 Rev 1/2004 Page 1 of 3 PAGE 2 14. You may use the optional authorization language provided below by checking off the designated spot in item 20 of this form. IF YOU HAVE CHOSEN TO AUTHORIZE THE DIRECT PAYMENT OF BENEFITS BY CHECKING THIS OPTION YOU MAY NOT ALSO...
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