Get Sc Occ-f005 2017-2025

Filling out the SC OCC-F005 form accurately is essential for effectively establishing a customer service agreement with Doctors Care. This guide provides a structured and detailed approach to assist users in completing the form online.

Follow the steps to successfully complete the SC OCC-F005 form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in Section I with your company's information. Include today's date, company name, number of employees, health insurance carrier, and contact details such as fax, phone, and address with city, state, and ZIP code.
3. Provide information for primary and secondary contacts. This includes their names, titles, addresses, phone numbers, fax, and emails.
4. Complete the billing information section. Enter the primary billing address, contact name, and title alongside their phone, fax, and email. Indicate if you wish to receive invoices via email.
5. Specify the required services and any wellness or onsite training services you wish to include. Make sure to check all that apply.
6. In the workers' compensation section, indicate how the claims should be billed and provide details about injury treatment and drug screening.
7. If applicable, fill out the billing and payment information section. Choose between recurring payment or balance billing and provide credit card details if necessary.
8. Review Section IV for any additional notes or fees that need to be applied as specified by your business development representative.
9. In Section V, provide the authorized person's name, signature, title, and date to finalize the agreement.
10. After completing the form, ensure to save your changes, download the completed form, print a copy, or share it as needed.

Complete your documents online for a streamlined experience.