Get the free AUTHORIZED TREATING PHYSICIAN NOTIFICATION - rmi prep colostate

AUTHORIZED TREATING PHYSICIAN NOTIFICATION Office of Risk Management and Insurance Fort Collins, Colorado 805236002 Phone: (970) 4916745 Fax: (970) 4914804 www.rmi.prep.colostate.edu If you are filing

How to fill out authorized treating physician notification

How to fill out authorized treating physician notification:

1. Start by entering the date at the top of the form.
2. Fill in your personal information, including your full name, address, phone number, and email address.
3. Provide your employer's information, such as the name of the company, address, and phone number.
4. Indicate the date of your injury or illness that requires medical attention.
5. Enter the name, address, and phone number of your authorized treating physician. This is the medical professional who will be responsible for your treatment.
6. Provide a brief description of your injury or illness and any known limitations or restrictions resulting from it.
7. Sign and date the form at the bottom.

Who needs authorized treating physician notification:

1. Employees who have sustained work-related injuries or illnesses are required to fill out an authorized treating physician notification.
2. This notification is necessary to inform both the employer and the workers' compensation insurance company about the medical professional who will be treating the employee.
3. It ensures that the employer and insurance company can contact the authorized treating physician for necessary documentation and updates on the employee's condition.

For pdfFiller’s FAQs

What is authorized treating physician notification?

Authorized treating physician notification is a form that informs the insurance carrier and other relevant parties of the physician responsible for managing the injured worker's care and treatment.

Who is required to file authorized treating physician notification?

The employer or insurance carrier is typically required to file the authorized treating physician notification.

How to fill out authorized treating physician notification?

The form can usually be filled out online or by submitting a paper form provided by the relevant state workers' compensation authority.

What is the purpose of authorized treating physician notification?

The purpose of the notification is to ensure that all parties involved in the workers' compensation claim are aware of who is overseeing the injured worker's medical care.

What information must be reported on authorized treating physician notification?

The form typically requires information such as the physician's name, contact information, license number, and the injured worker's name and claim number.

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