Notice to Change Physician of Record The physician selected must be BWC certified or the injured worker will be responsible for payment. Part I Instructions for the injured worker Please complete.
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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.
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What is a BWC physician of record?
A BWC physician of record is the healthcare provider responsible for overseeing the treatment of an injured worker in Ohio. This physician plays a critical role in determining the level of care and the recovery plan. Establishing a strong relationship with the selected physician can greatly impact the recovery process. Tools like the OH C-23 can help navigate encounters with healthcare records seamlessly.
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