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FORM C42Tennessee Bureau of Workers Compensation 220 French Landing Drive, IB Nashville, Tennessee 372431002 EMPLOYEES CHOICE OF Physician employer must provide a partially completed form listing
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How to fill out employee choice of physician
How to fill out employee choice of physician
01
Obtain the employee choice of physician form from the human resources department or from the employer.
02
Fill in the employee's personal information such as name, employee ID, and department.
03
Select the preferred physician or medical provider from the list provided on the form.
04
Sign and date the form to confirm the choice of physician.
05
Return the completed form to the human resources department or employer for processing.
Who needs employee choice of physician?
01
Employees who are covered under a health insurance plan provided by their employer.
02
Employers who offer health insurance plans to their employees.
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What is employee choice of physician?
Employee choice of physician is a process where an employee can choose their own doctor for work-related injuries or illnesses.
Who is required to file employee choice of physician?
Employers are required to provide the necessary forms to employees for filing employee choice of physician.
How to fill out employee choice of physician?
Employees can fill out employee choice of physician by indicating their chosen doctor's information and signing the form.
What is the purpose of employee choice of physician?
The purpose of employee choice of physician is to ensure that employees receive medical treatment from a healthcare provider of their choice for work-related injuries or illnesses.
What information must be reported on employee choice of physician?
Employee choice of physician form must include the chosen doctor's name, contact information, and signature of the employee.
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