Get Tx Dwc053 2012-2025

The TX DWC053 form is an essential document for employees seeking to change their treating doctor within the Texas workers' compensation system. This guide provides clear, step-by-step instructions to assist users in filling out the form online, ensuring a straightforward and efficient process.

Follow the steps to complete the TX DWC053 form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering your personal information in Section I. This includes your name, social security number, mailing address, and contact numbers. Ensure all information is accurate and clearly printed.
3. In Section II, provide details about your employer at the time of your injury, including the employer's name and address.
4. In Section III, fill in the insurance carrier information. Include the carrier's name, address, and contact details, including the adjuster's name, telephone number, and fax number.
5. Proceed to Section IV, where you will list information about your current treating doctor. Include their name, title, contact information, and mailing address. Additionally, provide the current treating doctor's license number if known.
6. In this section, explain why you are requesting a change of treating doctor in the designated field. If necessary, attach additional sheets to fully detail your reasons.
7. Provide the requested treating doctor's name, title, and contact information. Ensure you check their willingness and availability to accept you as a patient.
8. Obtain and enter the requested treating doctor’s license number and fax number, along with their mailing address.
9. Have the requested treating doctor sign the form in the designated area to confirm their agreement to take you on as a new patient.
10. Sign and date the form in Section V to authorize the change of treating doctor and the release of relevant medical records.
11. Once all sections are completed, save your changes, then you can download, print, or share the form as needed.

Complete your TX DWC053 form online with confidence and ensure your request is processed smoothly.