Get the free Pre-Designation of Personal Physician If you are injured on ...
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ALLAN HANCOCK COLLEGE
WORKERS COMPENSATION Redesignation of Personal Physician
EMPLOYEE NAME Title you are injured on the job you have the right to be treated by your personal physician if you notify
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How to fill out pre-designation of personal physician
How to fill out pre-designation of personal physician
01
Obtain the pre-designation form from your employer or insurance provider.
02
Fill out your personal information including name, address, date of birth, and policy number.
03
Enter the name and contact information of the physician you wish to designate as your personal physician.
04
Sign and date the form before submitting it to your employer or insurance provider.
Who needs pre-designation of personal physician?
01
Individuals who have health insurance coverage and want to designate a specific physician as their primary care provider.
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What is pre-designation of personal physician?
Pre-designation of personal physician is a process that allows an employee to choose a specific healthcare provider as their primary physician to manage their medical care, particularly in the context of workers' compensation.
Who is required to file pre-designation of personal physician?
Employees who are covered by workers' compensation insurance and wish to choose their own personal physician for medical treatment are required to file a pre-designation form.
How to fill out pre-designation of personal physician?
To fill out the pre-designation form, employees need to provide their personal information, the name and contact details of their chosen physician, and may need to sign the form to confirm their selection.
What is the purpose of pre-designation of personal physician?
The purpose of pre-designation of personal physician is to empower employees to select a physician they trust for their medical care, ensuring continuity of care and potentially improving outcomes after a work-related injury.
What information must be reported on pre-designation of personal physician?
The information that must be reported includes the employee's name, contact information, the physician's name, address, phone number, and a statement from the physician agreeing to treat the employee.
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