Get Ga Wc-200a 2018-2025

The GA WC-200a form is crucial for individuals seeking to change physicians or request additional treatment under the Georgia workers' compensation system. This guide provides clear, step-by-step instructions to assist users in accurately completing the form online.

Follow the steps to fill out the GA WC-200a form online successfully.

1. Click ‘Get Form’ button to access the GA WC-200a form and open it in the document editor.
2. Begin by filling out the employee's identifying information. This includes the employee's last name, first name, middle initial, date of injury, county of injury, mailing address, email address, city, state, and zip code.
3. Next, provide information regarding the physicians involved in the treatment. Identify the currently authorized treating physician by entering their name, city, state, and zip code.
4. Then, indicate the authorization request for treatment by another physician. Specify the name and city of the requested physician for further treatment.
5. Describe the additional treatment that is being authorized within the form. Be as specific as possible to ensure clarity.
6. In the agreement section, confirm that both parties approve the change in treating physician and identify who will be responsible for payment of medical expenses. Ensure the effective date is noted accurately.
7. Document any agreements regarding additional medical treatment and provide the effective date for this treatment as well.
8. Have both the employee or their representative and the employer or their representative sign the form. Include the printed names and mailing addresses for both parties.
9. Complete the certificate of service section by certifying that copies of this form have been provided to all relevant parties. Include the signature, email, date, and phone number.
10. Finally, review all entered information for accuracy. Once everything is complete, you can choose to save changes, download the form, print it, or share it as needed.

Complete the GA WC-200a form online to ensure a smooth process for changing your healthcare provider or obtaining additional treatment.