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SAVE PRINT CLEAR REDESIGNATION OF PERSONAL PHYSICIAN In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness by your personal medical

How to fill out texas predesignation form

How to fill out the Texas predesignation form:

1. Obtain the form: First, you need to obtain a copy of the Texas predesignation form. This can usually be found on the website of the Texas Workers' Compensation Commission or through your employer's human resources department.
2. Personal information: Fill in your personal information accurately on the form. This includes your full name, address, contact information, and social security number. Make sure to double-check the accuracy of this information before submitting the form.
3. Employer information: Provide your employer's details on the form. This includes the name of your employer, their address, and their contact information. If you have multiple employers, you may need to fill out separate forms for each employer.
4. Designation of doctor: Indicate the name and contact information of the doctor you wish to designate as your treating doctor for any work-related injuries. This doctor will be responsible for providing medical treatment and guidance if you get injured on the job.
5. Employee's signature: Sign and date the form to indicate your consent. By signing the form, you acknowledge that you understand the implications and effects of predesignating a doctor under Texas law.

Who needs the Texas predesignation form:

1. Employees covered under the Texas Workers' Compensation Act: Any employee who is covered under the Texas Workers' Compensation Act can benefit from filling out the predesignation form. This allows them to choose a specific doctor to provide them with medical treatment in case of a work-related injury.
2. Employees with preferred doctors: If you already have a trusted doctor who you prefer for medical treatment, filling out the predesignation form can ensure that you receive treatment from that particular doctor if you ever get injured at work.
3. Employees seeking continuity of care: By predesignating a doctor, employees can ensure continuity of care if they have an ongoing medical condition that requires consistent treatment. This can be particularly beneficial for individuals with chronic illnesses or pre-existing conditions.

Remember to consult with your employer or legal counsel to ensure that predesignation is applicable and permitted in your specific situation. It is also important to stay informed about any updates or changes to the predesignation requirements under Texas law.

For pdfFiller’s FAQs

What is texas predesignation form?

Texas predesignation form is a form that allows employees to designate their own physician or healthcare provider for any work-related injuries or illnesses. This form enables employees to receive medical treatment from their chosen provider instead of a physician selected by their employer or workers' compensation insurance carrier.

Who is required to file texas predesignation form?

All employees in Texas have the right to file a predesignation form to designate their own physician or healthcare provider for any work-related injuries or illnesses. It is not mandatory, but recommended for employees who want to have control over their medical treatment.

How to fill out texas predesignation form?

To fill out the texas predesignation form, an employee needs to provide basic personal information such as name, address, and contact details. They also need to include the name and contact information of the physician or healthcare provider they wish to designate. The form must be signed and dated by the employee.

What is the purpose of texas predesignation form?

The purpose of the texas predesignation form is to give employees the ability to choose their own physician or healthcare provider for any work-related injuries or illnesses. By designating a preferred provider, employees can ensure they receive medical treatment from a trusted healthcare professional.

What information must be reported on texas predesignation form?

The texas predesignation form typically requires the following information to be reported: employee's name, address, contact details, and the name and contact information of the designated physician or healthcare provider.

When is the deadline to file texas predesignation form in 2023?

The deadline to file the texas predesignation form in 2023 may vary depending on the employer's policies. It is recommended to check with the employer or the workers' compensation insurance carrier for the specific deadline.

What is the penalty for the late filing of texas predesignation form?

There may not be a specific penalty for the late filing of the texas predesignation form. It is important to consult the employer or the workers' compensation insurance carrier in case of any late filing consequences.

Can I sign the texas predesignation form electronically in Chrome?

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