Get Ca Dwc Form 9783 2007-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the CA DWC Form 9783 online
This guide provides essential information on completing the CA DWC Form 9783 online, a crucial document for employees seeking to designate a personal physician for work-related injuries or illnesses. The process is straightforward, ensuring that you can easily navigate each section.
Follow the steps to fill out the CA DWC Form 9783 accurately.
- Press the ‘Get Form’ button to obtain the CA DWC Form 9783 and open it in your preferred online editor.
- In the 'Employee' section, enter your name in the designated area provided. This is important for identifying who the form pertains to.
- Next, fill in your complete address in the provided fields, ensuring accuracy for future communication regarding your health care.
- In the 'To' section, write the name of your employer. This shows that you are notifying them of your choice of medical treatment provider.
- Specify the name of your selected physician (either M.D., D.O., or medical group) in the appropriate field, ensuring you have the correct title.
- Provide the complete street address, city, state, and ZIP code of your chosen physician or medical group to avoid any confusion in treatment.
- Fill in the physician’s or medical group's telephone number correctly, as this information is vital for your employer’s records.
- Print your name in the designated area to validate your signature, showing your agreement to the content of the form.
- Sign and date the form in the specified areas, confirming your request to designate a personal physician for work-related injuries.
- If applicable, ensure your physician or their designated employee signs and dates the form to affirm their agreement to provide treatment.
- Finally, save your changes, download the completed form for your records, and share it as required with your employer.
Take the next step and complete your CA DWC Form 9783 online to ensure your predesignation is correctly filed.
Related links form
DWC stands for the Division of Workers' Compensation in the State of California. This division is responsible for overseeing the workers' compensation system, ensuring injured workers receive the benefits they deserve. Familiarity with terms like DWC can provide you with a more comprehensive understanding of the process, especially when dealing with forms such as the CA DWC Form 9783.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.