Get Eisenhower Occupational Authorization For Treatment - Emcorg - Emc

This guide provides clear, step-by-step instructions on how to complete the EISENHOWER OCCUPATIONAL AUTHORIZATION FOR TREATMENT form online. Users will benefit from a comprehensive overview of each section to ensure accurate completion.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to obtain the form and access it in the editor.
2. Enter the employee's name in the designated field and specify the date.
3. Provide the company's name and contact phone number in the respective fields.
4. Indicate the name of the person authorizing treatment and their title.
5. Select 'Yes' or 'No' regarding the availability of modified work. Ensure to check the appropriate box.
6. In the authorization section, check all applicable services, including work injury, urine drug screen, or physicals as needed.
7. Fill in the appointment date and time for the required services.
8. Complete the current worker compensation carrier information by providing the name, address, policy number, adjuster's name, and phone.
9. Add any special instructions or comments that may be relevant to the treatment process.
10. Review all entered information for completeness and accuracy. Once confirmed, save your changes, then download, print, or share the completed form as needed.

Complete your documents online today to ensure a smooth process.