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DocuSign Envelope ID: 56012C9C59BA47F1B4592E2B19C8E5EADEPARTMENT OF STATE HEALTH SERVICES CONTRACT NO. 53718014800001 AMENDMENT NO. 02 RENEWAL THE DEPARTMENT OF STATE HEALTH SERVICES (\” System

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What is mod 1 td medical?

Mod 1 td medical is a form used for reporting medical expenses for worker's compensation claims.

Who is required to file mod 1 td medical?

Employers are required to file mod 1 td medical for employees who have incurred medical expenses related to a work-related injury or illness.

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Mod 1 td medical can be filled out by providing details of the medical expenses incurred by the employee, including the dates of service, type of service, and cost.

What is the purpose of mod 1 td medical?

The purpose of mod 1 td medical is to accurately report and document the medical expenses related to worker's compensation claims.

What information must be reported on mod 1 td medical?

Information that must be reported on mod 1 td medical includes the employee's name, date of injury, medical provider information, and details of the medical treatment received.

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