Election of Healthcare Provider for Workplace Injuries

Last UpdatedApril 11, 2024
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This form can be used by employees who to indicate that, in the event of an on-the-job injury, the employee would either (A) prefer to be treated by the Company's designated physician or (B) prefer to be treated by their own designated healthcare provider.

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Election Healthcare Provider -1.ONBE.3008.01CA.pdf
Note: This sample form is provided as a tool for employers. This form is general in nature, and may not be required by law. ManagEase is not a law firm. This form does not constitute legal advice, nor is any attorney-client relationship created or implied. Prior to using this form, we recommend that you consult with an attorney knowledgeable in any potentially applicable federal and/or state laws regarding the specific intended use of this form.
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