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Change of Physician Additional Treatment by Consent State Board of 2018-2026

Use a Change Of Physician Additional Treatment By Consent State Board Of 2018 template to make your document workflow more streamlined.

(b). Board Claim No. EMPLOYEE Employee Last Name Employee First Name M.I. Date of Injury A. IDENTIFYING INFORMATION County of Injury Mailing Address E-mail Address City State Zip Code B. PHYSICIANS / TREATMENT Mailing Address 1. The currently authorized treating physician is Dr.: Name City State Zip Code State Zip Code Mailing Address 2. The Authorization is requested for treatment by Dr.: Name City 3. The additional treatment authorized is: C. AGREEMENT 1. The parties...

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Understanding the Change of Physician Additional Treatment by Consent

The Change of Physician Additional Treatment by Consent form is a crucial document in the Georgia workers' compensation system. It allows an injured worker to formally request a change in their treating physician. This form is essential for ensuring that the medical care provided aligns with the worker's needs and preferences. By completing this form, the injured worker can seek additional treatment from a new physician, which can significantly impact their recovery process and overall well-being.

Steps to Complete the Change of Physician Additional Treatment by Consent

Completing the Change of Physician Additional Treatment by Consent form involves several key steps:

  • Gather necessary information: Collect details about your current physician, the proposed new physician, and the reasons for the change.
  • Fill out the form: Ensure all required fields are completed accurately, including your personal information and the specifics of your workers' compensation case.
  • Obtain consent: Both the current and new physicians may need to sign the form, indicating their agreement to the change.
  • Submit the form: Send the completed form to the appropriate workers' compensation board or insurance provider as instructed.

Legal Use of the Change of Physician Additional Treatment by Consent

This form holds legal significance within the context of workers' compensation claims in Georgia. It serves as a formal request that, when properly completed and submitted, can facilitate the transition to a new healthcare provider. Adhering to the legal requirements associated with this form is essential to ensure that the change is recognized and that the injured worker continues to receive the necessary medical care without interruption.

State-Specific Rules for the Change of Physician Additional Treatment by Consent

Georgia has specific regulations governing the use of the Change of Physician Additional Treatment by Consent form. It is important to be aware of these rules to ensure compliance:

  • The form must be submitted within a specific timeframe following the initial treatment.
  • Both the current and new physicians must be authorized to treat workers' compensation cases in Georgia.
  • Failure to follow the proper procedures may result in delays or denial of the request.

Examples of Using the Change of Physician Additional Treatment by Consent

Consider scenarios where an injured worker might utilize this form:

  • A worker experiencing ongoing pain may wish to switch to a specialist who has a better track record with their specific injury.
  • If a worker feels that their current physician is not providing adequate care, they can use this form to seek a second opinion from another provider.
  • In cases where a worker relocates, this form allows them to find a new physician closer to their new home while maintaining their workers' compensation benefits.

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*2011 GA WC-200a [2011-07] 20184.8 Satisfied (4069 Votes)
*2011 GA WC-200a [2011-07] 20114.8 Satisfied (4082 Votes)
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Related links to Change Of Physician Additional Treatment By Consent State Board Of
U.S. Department of Health & Human Services

Apr 18, 2025 — " Inform your health care practitioner (doctor) thar you wear contact lenses. " Never use tweezers or other toots to remove lenses from the ...Read more

20 CFR § 702.406 - Change of physicians; non-emergencies.

In all other cases, consent may be given upon a showing of good cause for change. (b) The district director for the appropriate compensation district may order ...Read more

Wisconsin Legislature: 448.30

Any physician who treats a patient shall inform the patient about the availability of reasonable alternate medical modes of treatment and about the benefits and ...Read more

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