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EMPLOYEE'S ACKNOWLEDGMENT OF PHYSICIAN PANEL NOTICE: MEDICAL TREATMENT FOR YOUR WORK INJURY OR OCCUPATIONAL ILLNESS Your employer has selected a list of 6 or more physicians and other health care
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What is employees acknowledgment of physician?
Employees acknowledgment of physician is a form completed by an employee acknowledging that they have been informed of their right to be treated by a physician of their own choice for a work-related injury or illness.
Who is required to file employees acknowledgment of physician?
Employers are required to have employees acknowledge the information about their right to choose a physician for work-related injuries or illnesses.
How to fill out employees acknowledgment of physician?
Employees can fill out the acknowledgment by signing and dating the form provided by their employer after reading the information about their rights.
What is the purpose of employees acknowledgment of physician?
The purpose of employees acknowledgment of physician is to ensure that employees are aware of their right to choose their own physician for any work-related injury or illness.
What information must be reported on employees acknowledgment of physician?
Employees must acknowledge that they have been informed of their right to choose their own physician for work-related injuries or illnesses.
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