Transfer of Attending Provider Form for Self Insured Workers Spanish Formulario para Trasferencia de Proveedor Principal para Trabajadores Autoasegurados

Transfer of Attending Provider Form for Self Insured Workers Spanish Formulario para Trasferencia de Proveedor Principal para Trabajadores Autoasegurados - (Forms/Publications)
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Title Transfer of Attending Provider Form for Self Insured Workers Spanish Formulario para Trasferencia de Proveedor Principal para Trabajadores Autoasegurados (25 KB DOC)
Description

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.

Detail
Form number F207-114-999
Availability
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Keywords attending doctor, attending physician, attending provider, change doctor, doctor, injured worker, new doctor, self insurance, self-insurer, transfer of care, Transfer of Care
Languages Spanish , English
Valid dates 12-2012
Contact information Self-Insurance

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