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Get Ca Dwc Form 9783 2014-2025
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How to fill out the CA DWC Form 9783 online
The CA DWC Form 9783 is essential for employees who wish to predesignate a personal physician for work-related injuries or illnesses. This guide provides a step-by-step approach to completing the form online, ensuring clarity for users regardless of their prior legal experience.
Follow the steps to complete the CA DWC Form 9783 online
- Press the ‘Get Form’ button to acquire the CA DWC Form 9783 and open it in your online editor.
- In the ‘To’ section, enter the name of your employer as indicated on the form.
- In the provided space, specify the name of your personal physician (M.D., D.O., or medical group) whom you wish to treat you for work-related injuries or illnesses.
- Fill in the street address, city, state, and ZIP code of the physician or medical group.
- Enter the telephone number of the chosen physician or medical group.
- In the section for Employee Name, print your name clearly.
- Provide your home address in the designated field.
- Indicate the name of the insurance company, plan, or fund that offers health coverage for nonoccupational injuries or illnesses.
- Sign and date the form in the space provided for Employee Signature.
- The physician may agree to this predesignation by signing in their section, which is not mandatory but recommended. If they do not sign, you will need to provide additional documentation.
- After completing the form, you can save your changes, download, print, or share the completed document as needed.
Complete your CA DWC Form 9783 online for efficient document management.
To fill out the DWC 1 form correctly, begin by entering your personal details, including your name and contact information. Next, describe the injury and provide details about how and when it occurred. The CA DWC Form 9783 can assist you in gathering the required information and ensuring you meet all necessary specifications for submission.
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