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9783.1. DWC Form 9783.1 Notice of Personal Chiropractor or Personal Acupuncturist. NOTICE OF PERSONAL CHIROPRACTOR OR PERSONAL ACUPUNCTURIST If your employer or your employer\'s insurer does not have
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How to fill out notice of personal chiropractor:

01
Gather all necessary personal information such as your full name, address, and contact details.
02
Fill in the date on which you are submitting the notice.
03
Write the recipient's information, including their name, title, and address. This could be your employer, insurance provider, or any other relevant party that requires the notice.
04
Clearly state the purpose of the notice, which is to inform the recipient that you have chosen a specific chiropractor for your personal healthcare needs.
05
Provide the chiropractor's information, including their name, address, and contact details.

Who needs notice of personal chiropractor?

01
Employees: If you have a health insurance plan that covers chiropractic services, your employer may require a notice stating which chiropractor you have chosen to receive treatment from.
02
Insurance providers: Some insurance companies may require a notice of personal chiropractor so that they can update their records and ensure that the approved chiropractors are providing the necessary services.
03
Healthcare organizations: If you are receiving healthcare services through an organization or program, such as Medicare or Medicaid, they may require a notice to keep track of your healthcare providers.
Overall, anyone who has a health insurance plan or receives healthcare services that cover chiropractic treatment may need to fill out a notice of personal chiropractor to inform the relevant parties about their chosen healthcare provider.
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The notice of personal chiropractor is a form that individuals must fill out to inform their employer that they are using the services of a personal chiropractor for any work-related injuries.
Any employee who is receiving treatment from a personal chiropractor for a work-related injury is required to file a notice of personal chiropractor.
To fill out a notice of personal chiropractor, the employee must provide their personal information, details of the chiropractor, treatment received, and any other relevant information requested on the form.
The purpose of the notice of personal chiropractor is to ensure that employers are aware of any work-related injuries being treated by a personal chiropractor and to help facilitate communication between the employee, chiropractor, and employer.
The notice of personal chiropractor must include the employee's personal information, details of the chiropractor, dates of treatment, diagnosis of injury, and any restrictions or limitations on work abilities.
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