Get Form Ca-16 - Branch43.com

Filling out the Form CA-16 is essential for obtaining authorization for medical treatment for injured employees. This guide provides a clear and supportive overview to help users complete the form accurately and efficiently online.

Follow the steps to complete the form seamlessly.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Fill in Part A by providing the name and address of the medical facility or physician authorized to provide treatment in the designated field.
3. Enter the employee's name using their last, first, and middle name in the appropriate section.
4. Indicate the date of injury by entering the month, day, and year in the specified format.
5. Provide the employee's occupation in the relevant field.
6. Describe the injury or disease clearly, ensuring to detail the nature of the medical condition.
7. Review the authorization conditions specified in item 6, check either box 1 or 2 to select the applicable option regarding treatment limitations.
8. The authorizing official must sign and date the form to certify agreement to the terms outlined.
9. Complete the local employing agency telephone number field to ensure contact information is clear.
10. Fill in the employee's place of employment address, including the department or agency and specific local address.
11. After completing all fields, review the form for accuracy and clarity.
12. Once all sections are complete, save changes, and you can proceed to download, print, or share the completed form as needed.

Complete your medical authorization forms online to ensure timely processing of treatment requests.