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NOTICE OF REDESIGNATION OF PERSONAL PHYSICIAN (Correlated Injury/Illness) OPTIONAL In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness

How to fill out elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx

How to fill out elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico:

1. Step one: Fill in your personal information. Provide your full name, address, phone number, and email address. Make sure all the information is accurate and up to date.
2. Step two: Indicate whether you are designating a personal physician, chiropractor, or acupuncturist. Check the appropriate box based on your preference.
3. Step three: Provide the contact information of your designated healthcare provider. Fill in their name, address, phone number, and email address. Again, ensure the information is correct.
4. Step four: Review the form and make any necessary revisions or corrections. Double-check that all the information is accurate and complete.
5. Step five: Sign and date the form. By signing, you are confirming that you understand and agree to the terms and conditions stated in the form.

Who needs elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico:

1. Students of California State University, Chico (CSU Chico) who want to pre-designate their personal physician, chiropractor, or acupuncturist for any work-related injury or illness.
2. Individuals who want to ensure that they have access to specific healthcare providers in case of a workplace injury or illness.
3. Those who have particular preferences or requirements for their healthcare and wish to have their chosen healthcare provider listed in their workers' compensation records.

Note: It is recommended to consult with CSU Chico's Human Resources or Workers' Compensation department for any specific guidelines or instructions related to the completion of this form.

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What is elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico?

The elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico is a document used to pre-designate a personal physician, chiropractor, or acupuncturist for workers' compensation purposes at CSU, Chico.

Who is required to file elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico?

All employees at CSU, Chico who wish to pre-designate a personal physician, chiropractor, or acupuncturist for workers' compensation purposes are required to file elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx.

How to fill out elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico?

To fill out the elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx at CSU, Chico, employees need to provide their personal information, contact details of the physician, chiropractor, or acupuncturist, and sign and date the form.

What is the purpose of elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico?

The purpose of the elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx is to allow employees at CSU, Chico to pre-select their preferred healthcare provider for workers' compensation cases.

What information must be reported on elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx - csuchico?

The elwc-pre-designation-of-personal-physician-chiropractor-or-acupuncturist-formdocx must include the employee's name, address, contact information, the name and contact details of the chosen physician, chiropractor, or acupuncturist, and the employee's signature.

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