Get Tx Oiec Intake Packet 2019-2025

Filling out the TX OIEC Intake Packet is an essential first step for individuals seeking assistance from the Office of Injured Employee Counsel. This guide will provide clear instructions on how to complete the packet online, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to complete the TX OIEC Intake Packet online

1. Click ‘Get Form’ button to obtain the TX OIEC Intake Packet and open it in your preferred online editor.
2. Fill out the Intake Form with your personal details, including last name, first name, last four digits of your social security number, phone number, email address, mailing address, and other required information. Make sure to provide accurate information related to your injury and treatment.
3. Complete the Treatment and Other Claim Information Form by listing all doctors, hospitals, and clinics that have treated you for your workers' compensation injury. Include addresses, phone numbers, and fax numbers for each provider. If you have not seen a doctor, check the relevant box.
4. Fill out the OIEC-31, HIPAA Authorization form. Ensure that all required sections are completed. Provide the name, address, and contact details of individuals authorized to disclose your health information.
5. Complete the OMB-02, Office of Injured Employee Counsel Assistance Request form, and provide all necessary details. Remember to sign and date the form.
6. After all sections are filled out, review the forms for accuracy. Make any necessary corrections to ensure the information is complete and correct.
7. Print all completed forms to sign where required. Once signed, you can choose to fax or mail them to the Office of Injured Employee Counsel at the provided address or fax number.
8. Save a copy of the filled forms for your records and ensure you have confirmation of submission if you are faxing them.

Complete the TX OIEC Intake Packet online today to ensure you receive the assistance you need.