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This document allows an employee to predesignate a personal physician for treatment of work-related injuries or illnesses, provided specific criteria are met.

How to fill out predesignation of personal physician

How to fill out Predesignation of Personal Physician

1. Obtain the Predesignation of Personal Physician form from your employer or health plan.
2. Fill in the required personal information, including your name, address, and contact information.
3. Provide the name and contact information of your chosen personal physician.
4. Indicate that you wish to predesignate this physician for future work-related injuries or illnesses.
5. Sign and date the form to acknowledge your understanding and consent.
6. Submit the completed form to your employer or health plan as instructed.

Who needs Predesignation of Personal Physician?

1. Employees who want to choose their personal physician for treatment of work-related injuries or illnesses.
2. Individuals who do not want to rely on the default designated medical providers offered by their employer or health plan.

People Also Ask about

What's the difference between a doctor and a physician?

A primary care provider may also be thought of as a “general practitioner,” or your personal doctor. They are the person who provides everyday health care and acts as a “health care home base” for your overall wellness.

What is your personal physician?

Personal physicians in concierge practices prioritize patient-centered care. They work closely with you to understand your health goals and develop a care plan that meets your unique needs. This approach allows for a more comprehensive and holistic approach to your health.

Is a personal physician a doctor?

They're also the provider you see for annual checkups. Your PCP gets to know you over the years and tailors care to your needs. PCPs are often doctors (commonly called primary care doctors). This means they go to medical school to earn their M.D. or D.O.

What does "personal physician" mean?

Personal physician means the physician indicated on the patient's medical record as being responsible for the medical care of that patient; Based on 7 documents.

What is the meaning of personal physician?

Personal physician means the employee's regular physician and surgeon who has previously directed the medical treatment of an employee and who retains the employee's medical records and history.

What does predesignation of personal physician mean?

prior to the injury your doctor agrees to treat you for work injuries or illnesses; • prior to the injury you provided your employer the following in writing: (1) notice that you want your personal doctor to treat you for a work-related injury or illness, and (2) your personal doctor's name and business address.

What do you call your personal physician?

A primary care physician (PCP), or primary care provider, is a health care professional who practices general medicine. PCPs are our first stop for medical care. Most PCPs are doctors, but nurse practitioners and physician assistants can sometimes also be PCPs.

For pdfFiller’s FAQs

What is Predesignation of Personal Physician?

Predesignation of Personal Physician is the process by which an employee informs their employer of their choice of a personal physician to provide medical treatment for work-related injuries or illnesses before an injury occurs.

Who is required to file Predesignation of Personal Physician?

Employees who wish to designate a personal physician for treatment of occupational injuries or illnesses are required to file a Predesignation of Personal Physician form with their employer.

How to fill out Predesignation of Personal Physician?

To fill out the Predesignation of Personal Physician form, employees must provide their personal and physician's details, including the physician's name, address, and contact information, as well as sign the form to acknowledge their choice.

What is the purpose of Predesignation of Personal Physician?

The purpose of Predesignation of Personal Physician is to ensure that employees receive medical care from a physician of their choice for work-related injuries, promoting better continuity of care.

What information must be reported on Predesignation of Personal Physician?

The information that must be reported includes the employee's name, the personal physician's name, address, telephone number, and a statement indicating the employee's consent to designate this physician for treatment of work-related injuries.