Get a Form or Publication: new doctor
Your search for "new doctor" returned 3 documents.
See also
| Title | Type | Number |
|---|---|---|
| Transfer of Attending Provider Form for Self Insured Workers Spanish Formulario para Trasferencia de Proveedor Principal para Trabajadores Autoasegurados
Also available in: English This form is used by self-insured injured workers who want to transfer their medical care. Self-insured workers should complete the form and send it to their employer or their Third Party Representative Este formulario es utilizado por los trabajadores autoasegurados que desean transferir su cuidado mdico. Los trabajadores autoasegurados deben completar este formulario y enviarlo a su empleador o a su Representante de Terceros. |
Form | F207-114-999 |
| Transfer of Care Card (Spanish) Tarjeta para Transferencia de Caso
Also available in: English Used by injured worker to notify claim manager and request authorization to transfer care to a different doctor. |
Form | F245-037-999 |
| Transfer of Care Card
Also available in: Spanish Used by injured worker to notify claim manager and request authorization to transfer care to a different doctor. Do it online! Use the online Transfer of Care |
Form | F245-037-000 |
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