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P.O. Box 32036, Lakeland, FL 338022036 NOTICE OF PHYSICIAN CHOICE & MEDICAL AUTHORIZATION Claimants Name: Claimants SS #: Employers Name: Injury Date: MWC #: I am claiming to have sustained an injury
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What is notice of physician choice?
Notice of physician choice is a form completed by injured workers in order to select a physician to provide medical treatment for a work-related injury.
Who is required to file notice of physician choice?
Injured workers with work-related injuries are required to file notice of physician choice.
How to fill out notice of physician choice?
To fill out notice of physician choice, injured workers must provide their personal information, details of the work-related injury, and select a physician from a list of approved providers.
What is the purpose of notice of physician choice?
The purpose of notice of physician choice is to allow injured workers to select a physician to provide medical treatment for their work-related injury.
What information must be reported on notice of physician choice?
Information such as personal details, work-related injury information, and selected physician must be reported on notice of physician choice.
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