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CC MSI HIS DWC 504 Provider PanelEmployee Request to Change Treating Doctor INSTRUCTIONS Please complete the form below and submit to CC MSI by: fax (713) 2188579; or email Houstonian CCMSI.com; or
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01
To fill out the hisdccmsiemployee change of treating form, follow these steps:
02
Obtain the hisdccmsiemployee change of treating form.
03
Read the form instructions carefully to understand the requirements and gather all necessary information.
04
Fill in your personal details at the top of the form, such as your name, employee ID, contact information, and the date.
05
In the 'Change of Treating Physician' section, provide the details of the new treating physician.
06
If applicable, provide the reason for the change and any supporting documentation.
07
Sign and date the form at the bottom to certify the accuracy of the information provided.
08
Submit the completed form to the appropriate department or authority as instructed.

Who needs hisdccmsiemployee change of treating?

01
Any employee who wishes to change their treating physician under the hisdccmsiemployee program needs to fill out the hisdccmsiemployee change of treating form. This form is required for employees who are under the hisdccmsiemployee program and want to switch their current treating physician to another one. It ensures that proper documentation is provided for the change and allows the program administrators to update the employee's records accordingly.
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Hisddcmsiemployee change of treating refers to the changes in the medical treating provider of a worker's compensation claim.
The employer or insurance company is usually required to file hisdccmsiemployee change of treating.
To fill out hisdccmsiemployee change of treating, the employer or insurance company must provide details of the new medical treating provider and the reason for the change.
The purpose of hisdccmsiemployee change of treating is to ensure that the worker receives appropriate and timely medical treatment for their work-related injury.
The information reported on hisdccmsiemployee change of treating typically includes the name and contact information of the new medical treating provider, the reason for the change, and any relevant medical records.
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