Get Form C42 Physician Panel - Occusure

The FORM C42 Physician Panel - OccuSure is a crucial document utilized in the Tennessee workers' compensation process. This guide provides clear, step-by-step instructions for completing the form online, ensuring a seamless experience for all users.

Follow the steps to complete the FORM C42 effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your online form editor.
2. Begin by filling out the employee's choice of physician section. Include the state file number and the date of injury, ensuring accuracy in each field.
3. Provide the employee's name, social security number, and address. Double-check for any typographical errors to maintain the integrity of the information.
4. Next, enter the employer's details, including their name, Federal Employer Identification Number (FEIN), and address.
5. In the panel of physicians section, list three physicians. If the injury is a back injury, include a fourth physician who must be a chiropractor. For each physician, include their name, phone number, address, and indicate if they are a specialist, specifying the specialty if applicable.
6. Select one physician from the panel by writing their name in the 'Physician Chosen' field. Make sure this choice is final.
7. Complete the form by adding your signature and the date selected to confirm your choices. It is essential that all required fields are filled out accurately.
8. Proceed to save changes, download the completed form, or print it for sharing. Make sure you keep a copy for your records.

Complete your FORM C42 online today to ensure compliance and support your workers' compensation process.