Get the free EMPLOYEES CHOICE OF PHYSICIAN - Tennessee

FORM C42 TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT Division of Workers\' Compensation 220 French Landing Dr. Nashville, Tennessee 372431002 AGREEMENT BETWEEN EMPLOYER/EMPLOYEE CHOICE

How to fill out employees choice of physician

How to fill out employees choice of physician

1. Obtain the necessary form for employees choice of physician from your employer or human resources department.
2. Fill out your personal information, including your name, address, and contact information.
3. On the form, indicate your current primary care physician if you have one.
4. Research and choose a new primary care physician if you do not currently have one. Consider factors such as location, specialization, and reputation.
5. Provide the name, address, and contact information of your chosen primary care physician on the form.
6. Review the completed form for accuracy and completeness.
7. Submit the form to your employer or human resources department as instructed.
8. Await confirmation and approval of your chosen primary care physician from your employer or insurance provider.

Who needs employees choice of physician?

1. Employees who have the option to choose their own primary care physician need to fill out the employees choice of physician form.
2. This form is usually required by employers or insurance providers to ensure proper coordination of healthcare services and to maintain an updated record of employees' chosen primary care physicians.
3. It is particularly important for employees who want to change their primary care physicians or who do not have an assigned primary care physician to fill out this form.

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What is employees choice of physician?

Employees' choice of physician refers to the right of an employee to select their own healthcare provider or doctor for their medical treatment, especially in cases related to work injuries.

Who is required to file employees choice of physician?

Employers are typically required to file the employees' choice of physician form if their state mandates it, usually in cooperation with the injured employee.

How to fill out employees choice of physician?

To fill out the employees' choice of physician form, an employee must provide their personal information, the selected physician's details, and sign the form to authorize the choice.

What is the purpose of employees choice of physician?

The purpose of the employees' choice of physician is to give injured workers the autonomy to choose a healthcare provider they trust for their treatment, ensuring better care and compliance.

What information must be reported on employees choice of physician?

The form must include the employee's name, contact information, the physician's name and address, and any necessary signatures.