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University of California, Los Angeles Personal Physician Redesignation Form (Workers Compensation) You can be treated immediately by your personal medical doctor (MD) or a Doctor of Osteopathy (DO)
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How to fill out personalphysicianpre-designationformdoc - upte-cwa
How to fill out personalphysicianpre-designationformdoc - upte-cwa:
01
Start by obtaining a copy of the form. You can typically find this form on your employer's website or by contacting your HR department.
02
Carefully read through the instructions and sections of the form to understand the information required.
03
Begin by filling out your personal information, such as your name, address, and contact information. Make sure to provide accurate and up-to-date details.
04
Next, you will need to provide information about your primary care physician or specialist that you wish to designate. This may include their name, address, phone number, and any other relevant details.
05
If you have any additional designated physicians, you may need to provide their information in the corresponding section of the form.
06
Some forms may ask for your employer's information or require you to provide details about your health insurance plan. Make sure to fill out these sections accurately.
07
Once you have completed all the required sections of the form, review it carefully to ensure that all the information is correct and legible.
08
Sign and date the form, as instructed. Some forms may require your physician's signature as well.
09
Make a copy of the completed form for your records and submit the original to the appropriate entity, such as your employer or health insurance provider.
Who needs personalphysicianpre-designationformdoc - upte-cwa?
01
Employees who have the option to choose their own primary care physician or specialist may need to fill out this form.
02
This form is commonly required by employers or health insurance providers to establish a pre-designated healthcare provider for the employee.
03
Individuals who want to ensure that they can receive care from a specific physician or specialist would need to fill out this form.
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