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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 section three attachment to?

Section three attachment is connected to Form XYZ.

Who is required to file section three attachment to?

Employers are required to file section three attachment.

How to fill out section three attachment to?

Section three attachment must be filled out with accurate information of employees.

What is the purpose of section three attachment to?

The purpose of section three attachment is to provide additional details about employees.

What information must be reported on section three attachment to?

Information such as employee's name, ID number, and relevant details must be reported on section three attachment.

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