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How to use or fill out physician additional with our platform
- Click ‘Get Form’ to open the physician additional form in the editor.
- Begin by filling out the identifying information section. Enter the Board Claim Number, Employee's Last Name, First Name, M.I., Date of Injury, and SSN or Board Tracking Number.
- In section A, provide details about the County of Injury and the name and address of your counsel if represented.
- Move to section B to identify the currently authorized treating physician. Fill in their name and address.
- Indicate whether you are requesting a Change of Physician or Additional Treatment by completing section C. Specify the names and addresses of the new physicians as needed.
- In section D, certify the existence of a valid fee contract if applicable.
- Finally, complete section E by certifying that all parties have been notified and sign with your details including date and contact information.
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