Get Oh C-23 1999-2026
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How to fill out the OH C-23 online
The OH C-23 form is essential for individuals seeking to change their physician of record in the workers' compensation system. This guide will walk you through each component of the form, ensuring you fill it out accurately and efficiently.
Follow the steps to complete the OH C-23 form online
- Press the ‘Get Form’ button to access the OH C-23 form and open it in your preferred platform.
- In Part I, fill in your details as the injured worker. This includes your name, date of injury, address, claim number, and phone number. Make sure each entry is correct and complete.
- Specify the changes you wish to make regarding your physician of record. Fill in the names, provider numbers, and addresses for both the current and new physicians.
- Indicate the reason for changing physicians by selecting from the provided options and providing detailed explanations where necessary. Pay special attention to ensure you clearly state your rationale.
- Answer whether you have received treatment from the new physician for your condition. If yes, specify the date of your first treatment.
- Sign the form in the designated area to confirm that the information you provided is accurate. This step is crucial for processing your request.
- After completing the form, submit all copies to your managed care organization (MCO) for record-keeping and processing.
- Ensure that the MCO completes Part II of the form as required, particularly notifying the Bureau of Workers' Compensation (BWC) of the change within 24 hours.
- Finally, you can save changes, download a copy, print it for your records, or share it as necessary.
Complete your documents online to ensure a smooth process!
Related links form
The Medco 14 form is designed to document a healthcare provider's request for medical treatment for a worker injured on the job. This form helps establish a clear connection between the treatment required and the workplace injury, ensuring compliance with OH C-23 guidelines. By submitting a complete and accurate Medco 14, you facilitate timely access to necessary care and resources that can aid in recovery. Accessing support services through the uslegalforms platform can assist you in navigating the details of this form effectively.