CA DWC Form 9783 2014-2025 free printable template

PRINT PREDESIGNATION OF PERSONAL PHYSICIAN In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness by your personal medical doctor (M.D.),

How to fill out predesignation personal physician form

How to fill out predesignation of personal physician

1. Obtain the predesignation form from your health insurance provider's website or customer service.
2. Fill in your personal details, including your full name, date of birth, and insurance ID number.
3. Write the name and contact information of the physician you wish to predesignate.
4. Ensure the physician is part of your insurance network to avoid additional costs.
5. Sign and date the form to confirm its accuracy.
6. Submit the completed form to your insurance provider, either online or by mail.
7. Keep a copy of the submitted form for your records.

Who needs predesignation of personal physician?

1. Individuals who have a health insurance plan that requires a designated primary physician.
2. Patients who frequently seek medical care and prefer to have a consistent healthcare provider.
3. Individuals managing chronic illnesses who need coordinated care.

People Also Ask about

What is the 9780.1 regulation?

(1) Notice of the predesignation of a personal physician is in writing, and is provided to the employer prior to the industrial injury for which treatment by the personal physician is sought.

What does personal physician mean?

Personal physician means a doctor of medicine, a doctor of osteopathy, or a doctor of chiropractic, who prior to the injury has directed the medical treatment of the employee and who retains the employee's medical records and medical history.

What is the designation of PTP?

The Professional Transportation Planner® (PTP) certification program is designed for candidates who have a wide-range of education and experience in transportation planning. Currently, no other certification program is offered that specifically addresses the work performed by transportation planners.

What is Labor Code 4061?

Labor Code §4061 is utilized to obtain a comprehensive medical legal evaluator in order to determine permanent indemnity issues or the need for future medical treatment (not used for an employee to object to a UR decision pursuant to LC section 4610).

What is the Labor Code 132a damages?

California Labor Code 132a establishes a policy that employers should not discriminate against workers who are injured in the workplace. The labor code provides for damages for any employee who is discriminated against for filing (or intending to file) a workers' compensation claim.

What is a 4600 letter workers compensation?

Download Form. This is a form that was created by the Division of Workers' Compensation, consistent with Labor Code Section 4600(d), to allow an injured worker to predesignate a physician prior to an industrial injury. The form itself lists the requirements to be able to predesignate a physician.

What does predesignation of personal physician mean?

If you pre-designate a physician, you will have to seek treatment through a designated medical facility until we receive documentation of the physician's agreement to be pre-designated. You are able to pre-designate a provider if the following conditions are met: Your employer offers group health coverage.

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What is predesignation of personal physician?

Predesignation of a personal physician allows an employee to choose a specific doctor to provide medical treatment for work-related injuries or illnesses before an incident occurs.

Who is required to file predesignation of personal physician?

Employees who wish to designate a personal physician for workers' compensation purposes are typically required to file predesignation forms with their employer.

How to fill out predesignation of personal physician?

To fill out the predesignation form, employees must provide their personal physician's information, including name, address, and medical license number, and submit it to their employer.

What is the purpose of predesignation of personal physician?

The purpose of predesignation of a personal physician is to ensure that employees have a say in their medical care and to expedite the treatment process in case of a work-related injury.

What information must be reported on predesignation of personal physician?

The information that must be reported includes the employee's name, the physician's name, contact information, medical license number, and possibly the physician's area of specialization.