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Personal Physician Designation Form

With this form, an employee can elect to receive medical treatment from his personal physician in case of an industrial injury or illness.

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Employers are required by law to provide all employees with an opportunity to pre-designate a physician for purposes of medical treatment in the event of a workplace injury. The form provides employees with notice of their rights and their doctor’s consent.

  • Easy-to-use, fill-in-the-blank format
  • Downloadable, RTF file for you to personalize
  • Sample form
This form is free for CalChamber members. Login and access the form now at HRCalifornia.com. Not a member? Find out more about the many benefits of membership.

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