Panel of Physicians- Orthopedic 2026

1. Click ‘Get Form’ to open the Panel of Physicians- Orthopedic in the editor.
2. Begin by selecting your preferred physician from the list provided on page 2. Ensure you choose a doctor who is available for your needs.
3. Indicate whether you are seeking medical treatment by checking the appropriate box. If not, acknowledge that you understand the process should treatment become necessary.
4. In the acknowledgment section, review the panel of physicians and initial to confirm your understanding of the work-related injury/illness notification process.
5. Complete the release of information section by providing your initials, printed name, signature, and date at the bottom of the form.
6. Once completed, save your document and return it via email or fax to the Workers’ Compensation Office as instructed.

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