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AREA DATE OF INJURY: CLAIM #: I understand that I have an initial choice of physicians for treatment of my job-related or occupational disease. I also understand that once I have been treated by a physician of my choice, I am not authorized to change physicians without first obtaining authorization from the Office of Workers Compensation or the . I DESIGNATE DR. FIRST NAME LAST NAME AS MY CHOICE OF PHYSICIAN. ( ADDRESS: STREET (PO BOX) CITY STATE, ZIP EMPLOYEE SIGNATURE: PRINT YO.

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Related content

Workers Compensation Resources | Travelers...
Throughout the claim process, you will need to fill out forms. Some will be ... Use this...
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Workers' Compensation | Risk Management and...
http://mywcinfo.com 800.252.4633. Contact CSU Workers' Compensation. 1251 S. Mason Street...
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To find your WCC email, you should first log into your Mywcinfocom Form account. Your email address will be displayed within your profile information. In case of difficulties, checking the help section of the WCC website can provide you with useful tips and contact details for technical support.

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To access your DCC email, start by logging into your Mywcinfocom Form account. After logging in, look for the email section on the dashboard. If you experience difficulties, check the college's IT resources for step-by-step instructions or contact support for assistance.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232