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EL CAMINO COMMUNITY COLLEGE DISTRICT Workers Compensation: Redesignation of Personal Physician Election Form If you have health insurance, and you are injured on the job you have the right to be treated

How to fill out pre-designation of personal physician

How to fill out pre-designation of personal physician

1. Obtain a pre-designation of personal physician form from your employer or insurance company.
2. Fill out your personal information such as name, contact details, and insurance policy number.
3. Provide the name and contact information of the physician you want to designate as your primary care provider.
4. Sign and date the form to certify that the information provided is accurate.
5. Submit the completed form to your employer or insurance company for processing.

Who needs pre-designation of personal physician?

1. Individuals who want to ensure they can see their preferred physician for routine healthcare visits.

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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 physician to provide medical treatment in the event of a work-related injury or illness.

Who is required to file pre-designation of personal physician?

Employees who wish to designate their personal physician for treatment related to work injuries or illnesses are required to file the pre-designation.

How to fill out pre-designation of personal physician?

To fill out the pre-designation form, employees must provide their personal physician's details, including name, address, and contact information, and submit it to their employer.

What is the purpose of pre-designation of personal physician?

The purpose of pre-designation is to ensure that employees can receive medical care from a trusted physician of their choice when dealing with job-related injuries or illnesses.

What information must be reported on pre-designation of personal physician?

The information required includes the employee's name, the physician's name, address, contact number, and possibly the physician's medical license number.