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Send dwc 53 form change of treating doctor via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out dwc 53 with our platform
- Click ‘Get Form’ to open the DWC 53 in the editor.
- Begin by filling out Section I, which includes your personal information. Enter your name, Social Security Number, mailing address, and contact details accurately.
- Proceed to Section II to provide your employer's information at the time of injury. Ensure you include the employer’s name and address.
- In Section III, input the insurance carrier's details including their name and contact information. This is crucial for processing your request.
- Section IV requires information about your current treating doctor. Fill in their name, contact number, and address. Don’t forget to explain why you are requesting a change in Section 21.
- Complete the requested treating doctor’s information in Section V. Make sure to have their signature as it confirms their willingness to treat you.
- Finally, sign and date the form in Section V to authorize the change of treating doctors before submitting it through our platform.
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