Form C42 Employee'S Choice Of Physician printable pdf download
C-42 Form. Keep the completed form on file and send a copy to the employee for their records. Individuals may receive, review and correct information that twc collects about the individual by emailing to open.records@twc.state.tx.us.
Form C42 Employee'S Choice Of Physician printable pdf download
Any business or employer that wants to grant an individual or service company. Keep the completed form on file and send a copy to the employee for their records. Alternative versions of the form are not allowed. Web written authorization may be revoked by grantor or grantee. Web employee fill out the bottom portion of this form to indicate which physician you choose. If you refuse to accept medical services from the chosen physician, your rights to benefits may be delayed. Individuals may receive, review and correct information that twc collects about the individual by emailing to open.records@twc.state.tx.us.
Web written authorization may be revoked by grantor or grantee. Any business or employer that wants to grant an individual or service company. Individuals may receive, review and correct information that twc collects about the individual by emailing to open.records@twc.state.tx.us. Alternative versions of the form are not allowed. Web employee fill out the bottom portion of this form to indicate which physician you choose. Keep the completed form on file and send a copy to the employee for their records. If you refuse to accept medical services from the chosen physician, your rights to benefits may be delayed. Web written authorization may be revoked by grantor or grantee.
