Designated physician form: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to change Designated physician form online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making adjustments to your paperwork takes only a few simple clicks. Make these quick steps to change the PDF Designated physician form online free of charge:

Register and log in to your account. Log in to the editor with your credentials or click on Create free account to examine the tool’s functionality.
Add the Designated physician form for editing. Click on the New Document button above, then drag and drop the sample to the upload area, import it from the cloud, or via a link.
Alter your document. Make any adjustments needed: insert text and images to your Designated physician form, underline details that matter, remove sections of content and replace them with new ones, and insert symbols, checkmarks, and fields for filling out.
Complete redacting the form. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the parties involved.

Our editor is very user-friendly and effective. Try it out now!

See more designated physician form versions

We've got more versions of the designated physician form form. Select the right designated physician form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2003	4.8 Satisfied (95 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

Can I choose my own doctor for workers comp in California?

Yes. [A]n injured worker has the right to select one physician or medical provider of his or her own choosing to render treatment. This chosen provider may make one referral of the worker to another specialist to continue treatment without any approval from the employer or its insurance carrier.

What does pre designate a physician mean?

Pre-designation of a Physician If you are injured at work, you are required to seek treatment at a designated medical facility. If you pre-designate a physician, you will have to seek treatment through a designated medical facility until we receive documentation of the physicians agreement to be pre-designated.

What is a designated physician?

What is a designated doctor? A designated doctor (DD) is selected by the Division of Workers Compensation (DWC) to resolve questions about an injured employees medical condition or resolve a dispute about a work-related injury or illness.

Should I Predesignate a physician?

As the California Department of Industrial Relations explains, you must have a predesignation of personal physician in place at the time of your work-related injury or illness. If you do not, you are required to be treated by a physician in your employers Medical Provider Network.

What is a personal physician?

Personal physician means a doctor of medicine, a doctor of osteopathy, or a doctor of chiropractic, who prior to the injury has directed the medical treatment of the employee and who retains the employees medical records and medical history.

Related forms

be ready to get more