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MEDICAL TREATMENT PROVIDER LIST (for injured employee to complete)Claimant Name:Social Security Number:Address:Date of Injury:Employer:Telephone Number:Cell Number:Notification to the Workers Compensation
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What is MEDICAL TREATMENT PROVIDER LIST Form?

The MEDICAL TREATMENT PROVIDER LIST is a fillable form in MS Word extension which can be completed and signed for specific needs. Then, it is provided to the exact addressee in order to provide specific information and data. The completion and signing is possible manually in hard copy or with an appropriate solution like PDFfiller. Such tools help to complete any PDF or Word file without printing them out. It also allows you to edit it depending on your requirements and put a valid e-signature. Upon finishing, the user ought to send the MEDICAL TREATMENT PROVIDER LIST to the respective recipient or several recipients by mail or fax. PDFfiller includes a feature and options that make your template printable. It offers a number of settings for printing out. It doesn't matter how you distribute a document - in hard copy or by email - it will always look well-designed and clear. To not to create a new document from the beginning every time, turn the original form into a template. Later, you will have an editable sample.

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The medical treatment provider list is a list of healthcare providers who have treated a worker for a work-related injury or illness.
Employers are required to file the medical treatment provider list.
The medical treatment provider list should be filled out with the names and contact information of healthcare providers who have treated a worker for a work-related injury or illness.
The purpose of the medical treatment provider list is to keep track of the healthcare providers who are treating workers for work-related injuries or illnesses.
The information reported on the medical treatment provider list includes the names and contact information of the healthcare providers who have treated a worker for a work-related injury or illness.
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