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Tennessee Bureau of Workers Compensation 220 French Landing Drive, IB Nashville, TN 372431002 FORM C42EMPLOYEES CHOICE OF PHYSICIAN An employer must provide a partially completed form listing at least

How to fill out employees choice of physician

How to fill out employees choice of physician

1. Start by obtaining the employees choice of physician form from the HR department or any designated representative.
2. Read the instructions carefully to understand the process and requirements.
3. Fill out the employee information section accurately, including the name, employee ID, and contact details.
4. Provide the effective date of the choice of physician.
5. Specify the chosen physician's name, contact information, and address.
6. If required, provide any additional information or documentation as mentioned in the form or instructions.
7. Review the filled form for any errors or missing information.
8. Sign and date the form to validate your choice of physician.
9. Submit the completed form to the HR department or follow the prescribed submission process.
10. Keep a copy of the filled form for your records.

Who needs employees choice of physician?

1. All employees who are eligible for the company's health insurance or healthcare benefits need to fill out the employees choice of physician form.
2. It allows employees to select a specific physician or healthcare provider as their primary caregiver, ensuring that they receive medical care from the chosen professional.
3. This form is necessary to establish the preferred physician for work-related injuries, ongoing medical treatments, and insurance claims processing.
4. Employees who want to maintain a consistent provider-patient relationship or have specific healthcare preferences should fill out this form.
5. It gives employees more control over their healthcare decisions, particularly in managed care or health maintenance organization (HMO) plans where choosing a primary physician is required.

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What is employees choice of physician?

Employees choice of physician is the option for employees to select their own doctor for medical treatment related to a work injury.

Who is required to file employees choice of physician?

Employers are required to provide employees with a choice of physician form to fill out.

How to fill out employees choice of physician?

Employees can fill out the choice of physician form by selecting their preferred doctor and providing any required information requested on the form.

What is the purpose of employees choice of physician?

The purpose of employees choice of physician is to give employees the ability to seek medical treatment with a doctor of their choosing when dealing with a work-related injury.

What information must be reported on employees choice of physician?

The choice of physician form typically requires employees to provide their selected doctor's contact information, as well as any additional information requested by the employer or insurance provider.