Employee Choice Of Physician Form {C-42}

C-42 - EMPLOYEE'S CHOICE OF PHYSICIAN. This form is used to document the selection of a physician by an employee who has reported a workplace injury. The employer provides the employee with a list of at least three physicians (including telehealth options), and the employee must select one for treatment. The employee must complete the form by choosing their preferred physician and indicating whether they wish to receive in-person or telehealth treatment. The form is then signed by the employee and returned to the employer. The employer is responsible for keeping a copy on file and providing the employee with a copy for their records. This form is not typically submitted to the state unless requested. www.FormsWorkflow.com