Refusal of medical treatment form california 2026

1. Click ‘Get Form’ to open the refusal of medical treatment form in the editor.
2. Begin by entering your employer's name and phone number at the top of the form. This information is crucial for identification purposes.
3. Fill in your personal details, including your name, social security number, department, date of injury, and the time you were injured. Ensure accuracy as this data is essential for processing.
4. In the section describing your injury, provide a clear account of what happened and specify which part of your body was affected. This helps document the incident thoroughly.
5. Read through the notification section carefully. It outlines your rights and obligations regarding medical care. Acknowledge that you have been offered medical attention but choose to decline it at this moment.
6. Sign and date the form where indicated. Ensure that both your supervisor's or foreman's signature and a witness signature are obtained to validate the document.

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