Get Or Occupational Medicine Service Authorization Form 2020-2025

This guide provides clear instructions on how to accurately complete the OR Occupational Medicine Service Authorization Form online. By following these steps, users can ensure that they provide all necessary information to facilitate their occupational medicine needs.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the 'Patient Name' field with the full name of the individual seeking services. Ensure that the name is spelled correctly.
3. Enter the 'Date' in the designated field. This should reflect the date you are filling out the form.
4. Select the type of 'Drug & Alcohol Testing' needed by checking the appropriate box for either DOT, Non-DOT, or Rapid Result.
5. Indicate the reason for the testing by selecting one of the options: Pre-placement, Post Accident, Random, Return to Duty, or Reasonable Suspicion.
6. For 'Injury Care', specify the 'Date of Injury' in the corresponding section, along with any post-accident drug and alcohol testing requirements.
7. In the 'Alcohol Testing' section, choose between Breath Alcohol Test or Saliva Alcohol Test, and fill in any additional required information, such as language for an interpreter if necessary.
8. For 'Examinations', check all applicable types of examinations needed.
9. In 'Immunizations and Other Services', select the vaccinations or lab tests that the person requires.
10. Provide any additional notes in the 'Additional Notes' section of the form as needed.
11. Complete the 'Company Name & Location' fields and ensure that the authorization is signed by the appropriate person.
12. Finally, save the completed form, and choose whether to download, print, or share it as necessary.

Take action now and complete your OR Occupational Medicine Service Authorization Form online.