Hrsc ups 2026

1. Click ‘Get Form’ to open the hrsc ups in the editor.
2. Begin with Section 1, where you will enter your Participant’s Information. Fill in your Identification Number, Full Name, Date of Birth, Complete Address, and Employer. If applicable, indicate the Date of Accident and answer questions regarding the accident's nature.
3. Proceed to Section 2 for the Physician’s Statement. Your treating physician must complete this section. Ensure they provide the Patient’s Name, Date Disability Began, Diagnosis, and treatment details.
4. Finally, complete Section 3 with your Employer’s Statement. This includes details about your last day worked and whether a Workers’ Compensation claim has been filed.
5. Once all sections are filled out accurately, submit the form by mailing it to TeamCare or faxing it as instructed.

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