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Click ‘Get Form’ to open it in the editor.
Begin by entering the date and date of injury (DOI) at the top of the form. This information is crucial for tracking treatment timelines.
Fill in the employee’s name, employer details, and contact person’s information. Ensure accuracy to avoid any delays in processing.
Select the job description for physicals by checking either 'Attached' or 'On File'. This helps streamline the referral process.
Provide the employer's signature along with the contact name, title, and phone number. This validates the form and confirms that all information is correct.
Indicate employee work hours by specifying start and end times. This section is important for scheduling appointments effectively.

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Does Kaiser Permanente take L.A. Care?

Thank you for choosing Kaiser Foundation Health Plan, Inc., as your plan partner through L.A. Care Health Plan (L.A. Care), a public entity serving Los Angeles County. This Member Handbook tells you about most health care coverage you get through Kaiser Permanente.

What is Kaiser Los Angeles ranked?

Nationwide, 4 Kaiser Permanente hospitals are in the top 50 for an area of specialty care: The Kaiser Permanente Los Angeles Medical Center is 23rd in California for overall care and 40th nationwide for neurology and neurosurgery.

What state does not have Kaiser Permanente?

As of 2024, Kaiser Permanente serves eight states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington) as well as the District of Columbia and is the largest managed care organization in the United States.

Is Kaiser available in Los Angeles?

Los Angeles Member Services is now available to meet with and assist Kaiser Permanente members and patients, using online audio and video capabilities. We look forward to assisting you.

Does LA have Kaiser?

Kaiser Permanente Los Angeles Medical Center. This is an exciting time! As you prepare to welcome your new baby, the care team at Kaiser Permanente Los Angeles looks forward to taking this journey with you.