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Redesignation Of Personal PhysicianPredesignation Of Personal Physician In the event you sustain an injury or illness related to your employment, you may be treated for such injury/illness by your

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How to fill out pre-injury personal physician pre-designation

01

Obtain the pre-injury personal physician pre-designation form from your employer or workers' compensation insurance carrier.

02

Fill out your personal information, including your name, address, and contact information.

03

Provide information about your chosen personal physician, including their name, address, and contact information.

04

Sign and date the form to acknowledge that you are designating this physician as your preferred provider for any work-related injuries.

Who needs pre-injury personal physician pre-designation?

01

Any employee who wants to designate their personal physician as the preferred provider for any potential work-related injuries needs to fill out the pre-injury personal physician pre-designation form.

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What is pre-injury personal physician pre-designation?

Pre-injury personal physician pre-designation allows an injured worker to choose their personal physician to provide medical treatment for a work-related injury or illness.

Who is required to file pre-injury personal physician pre-designation?

Employees who want to designate their personal physician for potential work-related injuries or illnesses.

How to fill out pre-injury personal physician pre-designation?

Employees can fill out the form provided by their employer or workers' compensation insurance carrier with their personal physician's information.

What is the purpose of pre-injury personal physician pre-designation?

The purpose is to ensure that injured workers receive treatment from a physician they trust and are comfortable with.

What information must be reported on pre-injury personal physician pre-designation?

It must include the personal physician's name, address, and contact information.

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