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This document allows employees to pre-designate their personal physician for treatment of work-related injuries or illnesses, complying with requirements set by the employer.
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How to fill out pre-designation of personal physician
How to fill out Pre-designation of Personal Physician
01
Obtain the Pre-designation of Personal Physician form from your employer or health insurance provider.
02
Fill out your personal information including your name, address, and contact details.
03
Indicate the name of the physician you wish to designate as your personal physician.
04
Provide the contact information of the designated physician, including their address and phone number.
05
Sign and date the form to confirm your agreement with the designation.
06
Submit the completed form to your employer's HR department or your health insurance provider.
Who needs Pre-designation of Personal Physician?
01
Employees who wish to designate a specific physician for their medical care within their health insurance plan.
02
Individuals enrolled in a health insurance plan that requires pre-designation to receive certain benefits.
03
Patients who want to ensure coordinated care through a preferred physician.
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People Also Ask about
Is your physician the same as your doctor?
A physician is a general term for a doctor who has earned a medical degree. Physicians work to maintain, promote, and restore health by studying, diagnosing, and treating injuries and diseases. Physicians generally have six core skills: Patient care.
What is your personal doctor?
What is a primary care doctor? A primary care doctor is the person you can rely on to help manage a wide variety of health care needs – both routine and expected. These doctors can help you with preventive care, like your routine physicals, screenings and immunizations.
What is a notice of pre designation of personal physician?
§ 9780.1. (1) Notice of the predesignation of a personal physician is in writing, and is provided to the employer prior to the industrial injury for which treatment by the personal physician is sought.
What is DWC form 9783?
You may use this form to notify your employer if you wish to have your personal medical doctor or a doctor of osteopathic medicine treat you for a work-related injury or illness and the above requirements are met. NOTICE OF PREDESIGNATION OF PERSONAL PHYSICIAN Employee: Complete this section.
What does "personal physician" mean?
(e) “Personal Physician” means (1) the employee's regular physician and surgeon, licensed pursuant to Chapter 5 (commencing with section 2000) of Division 2 of the Business and Professions Code, (2) who has been the employee's primary care physician, and has previously directed the medical treatment of the employee,
What is an example of a personal physician?
For example, PCPs include: Pediatricians: Doctors who care for newborns, infants, children, and adolescents. Geriatricians: Doctors who care for older adults with medical needs related to aging. Internists: Doctors who care for adults of all ages for a variety of medical problems.
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.
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.
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What is Pre-designation of Personal Physician?
Pre-designation of Personal Physician is a process that allows an employee to choose their own personal physician to provide medical treatment for work-related injuries before an injury occurs.
Who is required to file Pre-designation of Personal Physician?
Employees who wish to designate a personal physician for work-related injuries are required to file the Pre-designation of Personal Physician form.
How to fill out Pre-designation of Personal Physician?
To fill out the Pre-designation of Personal Physician form, the employee must provide their personal information, including name and contact details, as well as the selected physician's information, including name, address, and medical license number.
What is the purpose of Pre-designation of Personal Physician?
The purpose of Pre-designation of Personal Physician is to ensure that employees receive medical treatment from a physician of their choice in the event of a work-related injury, enhancing the employee's comfort and trust in their medical care.
What information must be reported on Pre-designation of Personal Physician?
The information that must be reported includes the employee's name, the name of the designated physician, the physician's address, and the physician's medical license number.
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