Transfer of Care Card (Spanish) Tarjeta para Transferencia de Caso

Transfer of Care Card (Spanish) Tarjeta para Transferencia de Caso - (Forms/Publications)
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Title   Transfer of Care Card (Spanish) Tarjeta para Transferencia de Caso (136 KB PDF)
Description

Used by injured worker to notify claim manager and request authorization to transfer care to a different doctor.

Detail
Form number F245-037-999
Availability
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Keywords attending physician, claims, espanol, industrial insurance, medical, new doctor, provider, spanish, worker's compensation, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 07-2012
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Web pages For Medical Providers
Workers' Comp Claims

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