Get Print Form Form 307 Medical Treatment Provider List Please Print Or Type Claimant Name Address

Filling out the Print Form Form 307 Medical Treatment Provider List is an essential step for workers' compensation claimants who need to provide information about their medical treatment providers. This guide will walk you through each section of the form to ensure you complete it accurately and efficiently.

Follow the steps to complete the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by entering your claimant name in the designated field. Ensure that your name is spelled correctly as it is recorded in formal documents.
3. Fill in your address in the provided fields, including street address, city, state, and ZIP code. Double-check for accuracy.
4. Enter your telephone number in the specified section so that the relevant parties can contact you if needed.
5. Input your social security number. Keep in mind that this information is sensitive and should be handled with care.
6. Provide the date of injury in the required format. This date is essential for the processing of your claim.
7. State the name of your employer in the next field. Ensure that this matches any official documentation.
8. List the names and addresses of medical providers who have treated you for any industrial injuries in the past 10 years in the appropriate sections.
9. If applicable, document any additional medical providers who have treated you for other medical issues. This field can accommodate treatment within the past 10 years.
10. Provide the name, address, and contact information of the party requesting the medical records, if needed. This should include their relationship to your claim.
11. After completing all sections, review your entries for accuracy before finalizing.
12. You can then save your changes, download a copy, print the completed form, or share it as required by your circumstances.

Complete your forms online with confidence and ensure your claim is processed smoothly.