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Division of Administration & Finance Human Resources ManagementEmployee Redesignation of Personal Physician The California Labor Code grants an employee who has sustained an occupational injury or

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How to fill out california pre-designation form

01

Download the California pre-designation form from the official website or obtain a physical copy from your employer.

02

Fill in your personal information such as name, address, and contact details.

03

Provide details of your personal physician or chiropractor including name, contact information, and specialty.

04

Sign and date the form, acknowledging that the information provided is accurate and up to date.

05

Submit the completed form to your employer or their designated representative.

Who needs california pre-designation form?

01

Employees who have a pre-existing condition and wish to designate their personal physician or chiropractor for treatment related to that condition.

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What is california pre-designation form?

California pre-designation form is a form that allows an employee to designate their personal physician or medical group prior to a work-related injury occurring.

Who is required to file california pre-designation form?

All employees in California have the right to pre-designate their personal physician or medical group.

How to fill out california pre-designation form?

To fill out the form, employees must provide their personal physician or medical group's information and submit the form to their employer.

What is the purpose of california pre-designation form?

The purpose of the form is to ensure that employees have access to quality medical care from a physician or medical group of their choosing in the event of a work-related injury.

What information must be reported on california pre-designation form?

The form must include the employee's personal physician or medical group's name, address, and contact information.

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