Pre-Designating a Doctor

Employees have the option of pre-designating their personal physician as their treating physician in the event of a work-related injury/illness. The Pre-designation of PhysicianPDF File Opens in new window form must be filled out and submitted prior to a work-related injury/illness. The law defines "personal physician" as (1) The employee's regular licensed physician or surgeon; (2) Who is the primary care physician and has previously directed the employee's treatment and retains the employee's medical records and medical history; (3) And who agrees to be pre-designated.

Employees bear the responsibility of keeping their physician pre-designation current. If you choose to pre-designate, the form must be completed and signed by you and your personal physician. Return the completed form to Total Wellness, CP-700.

If you have pre-designated a physician but are unable, at the determination of your supervisor, to drive due to the extent of your work-related injury/illness or to arrange timely transportation to that location, your supervisor will arrange for you to be transported.

This physician pre-designation form is also available in the Forms section along the right side of this website.