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Form101006HUMAN RESOURCES OFFICE 11555 Old Oregon Trail, Redding, CA 96003 Telephone: (530) 2427640compensation: Redesignation of Personal Physician If your employer offers group health insurance,

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How to fill out predesignation of personal physician

01

Step 1: Obtain the predesignation of personal physician form from your healthcare insurance provider.

02

Step 2: Fill out your personal information, including your name, date of birth, and insurance policy number.

03

Step 3: Provide the name, address, and contact information of the physician you wish to designate as your personal physician.

04

Step 4: Sign and date the form.

05

Step 5: Submit the completed form to your healthcare insurance provider as instructed.

06

Step 6: Keep a copy of the form for your records.

Who needs predesignation of personal physician?

01

Anyone who has a healthcare insurance policy and wants to designate a specific physician as their personal physician may benefit from the predesignation of personal physician. It allows individuals to have a preferred doctor who can coordinate their healthcare and provide personalized medical attention.

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What is predesignation of personal physician?

Predesignation of personal physician is a process where an employee can choose their personal physician before an injury and designate them as the primary physician for workers' compensation purposes.

Who is required to file predesignation of personal physician?

Employees who want to choose their personal physician for workers' compensation purposes are required to file predesignation of personal physician.

How to fill out predesignation of personal physician?

The employee must complete the predesignation form provided by their employer and submit it to the employer's workers' compensation insurance carrier.

What is the purpose of predesignation of personal physician?

The purpose of predesignation of personal physician is to allow employees to choose a physician they trust to provide medical treatment in case of a work-related injury.

What information must be reported on predesignation of personal physician?

The employee must report their chosen physician's name, address, telephone number, and medical specialty on the predesignation form.

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