Employer Authorization - Med Express 2026

1. Click ‘Get Form’ to open the Employer Authorization - Med Express in the editor.
2. Begin by entering the employee's name and Social Security Number (SSN) in the designated fields. Ensure accuracy for efficient processing.
3. Fill in the company name, address, city, state, and zip code. This information is crucial for identifying the employer.
4. Provide details of the Designated Employer Representative (DER), including their name and phone number. This person will be responsible for authorizing services.
5. Indicate whether there is an existing account at this location by selecting 'Yes' or 'No'. If no account exists, check 'Contact me to set up an account'.
6. Select the relevant services required under Workers Compensation, Alcohol Testing, Physical Examinations, and Ancillary Services by checking appropriate boxes.
7. Complete the MRO Info section with necessary contact details if applicable.
8. Finally, ensure that an authorized signature is provided along with the date. Specify how results should be relayed (fax or email).

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