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Declination of Medical Treatment City of Los Angeles Medical Services DepartmentDeclination of Medical Treatment Employee Name:EMP ID:Job Title Date of InjuryAffected body parts(i.e. left elbow, right
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Non-dhsnon-county workforce members who are not covered under the DHS or county health insurance plans.
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Non-DHS non-county workforce member health refers to the health and wellness information pertaining to employees who are not part of the Department of Homeland Security (DHS) or county-based health programs.
Employers or organizations that employ non-DHS and non-county workforce members are required to file non-DHS non-county workforce member health.
To fill out non-DHS non-county workforce member health, complete the designated form with relevant employee health information, including personal details, job-related health risks, and exposure to health programs.
The purpose of non-DHS non-county workforce member health is to monitor and promote the health and safety of employees not covered under DHS or county programs, ensuring compliance with health regulations.
Reported information typically includes employee identification, health assessment results, any workplace-related health conditions, and participation in health programs.
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