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Go to Form Instructions for Completing the NOTICE OF ONE-TIME CHANGE OF PHYSICIAN & AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION Please read all pages This form is fillable. That means you can
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How to fill out wc003 noticeofonetimechangephysiciandoc - colorado
How to fill out wc003 noticeofonetimechangephysiciandoc - colorado:
01
Firstly, download the wc003 noticeofonetimechangephysiciandoc form from the official website of the Colorado Division of Workers' Compensation. Ensure that you have the most recent version of the form.
02
Begin by entering the relevant information in the top section of the form. This includes the injured worker's name, address, social security number, and date of injury.
03
Indicate the current treating physician's details in the designated section. This includes the physician's name, address, and phone number. If the physician is a specialist, specify the field of specialization as well.
04
In the "New Attending Physician Information" section, provide the details of the physician to whom the injured worker wishes to change. Enter the new physician's name, address, and phone number. Again, if the new physician is a specialist, mention the field of specialization.
05
The injured worker must sign and date the form to certify the information provided.
06
After completing the form, make copies for your records and keep a copy to submit to the Colorado Division of Workers' Compensation.
Who needs wc003 noticeofonetimechangephysiciandoc - colorado?
01
Injured workers in Colorado who want to change their attending physician in their workers' compensation case need to fill out wc003 noticeofonetimechangephysiciandoc.
02
This form is for individuals who have already started receiving medical treatment for their work-related injury but wish to switch to a different physician for further treatment.
03
The wc003 noticeofonetimechangephysiciandoc form is required by the Colorado Division of Workers' Compensation to ensure that proper documentation is in place when a change of attending physician occurs during the workers' compensation claim process.
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What is wc003 noticeofonetimechangephysiciandoc - colorado?
WC003 Notice of One-Time Change Physician Document in Colorado is a form used to report a one-time change in physician for workers' compensation cases.
Who is required to file wc003 noticeofonetimechangephysiciandoc - colorado?
The employer or insurance carrier is required to file the WC003 Notice of One-Time Change Physician Document in Colorado.
How to fill out wc003 noticeofonetimechangephysiciandoc - colorado?
The form should be completed with the necessary information such as the injured worker's details, current physician information, and the new physician information.
What is the purpose of wc003 noticeofonetimechangephysiciandoc - colorado?
The purpose of WC003 Notice of One-Time Change Physician Document in Colorado is to document any changes in the treating physician for workers' compensation cases.
What information must be reported on wc003 noticeofonetimechangephysiciandoc - colorado?
The form requires information such as the injured worker's name, date of injury, current physician's name and contact information, and the new physician's name and contact information.
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