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State of California Division of Workers Compensation REQUEST FOR AUTHORIZATION FOR MEDICAL TREATMENT Section Three Attachment to PR2 DATE OF REQUEST: Patient Name: Employer Name: Claim Number: Date

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What is request for authorization for?

Request for authorization is for seeking permission or approval for a certain action or activity.

Who is required to file request for authorization for?

Anyone who needs to obtain authorization or approval for a specific action or activity.

How to fill out request for authorization for?

To fill out a request for authorization, you need to provide details about the action or activity being requested, the purpose of the request, and any other relevant information.

What is the purpose of request for authorization for?

The purpose of request for authorization is to ensure that proper approval is obtained before carrying out a certain action or activity.

What information must be reported on request for authorization for?

The information required on a request for authorization typically includes details about the requester, the action or activity being requested, the purpose of the request, and any supporting documentation.

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