Notice To Change Physician Of Record {BWC-1128} | Pdf Fpdf Doc Docx | Ohio

 Ohio   Workers Comp   Injured Workers 
Notice To Change Physician Of Record {BWC-1128} | Pdf Fpdf Doc Docx | Ohio

Last updated: 3/9/2025

Notice To Change Physician Of Record {BWC-1128}

Start Your Free Trial $ 13.99
200 Ratings
What you get:
  • Instant access to fillable Microsoft Word or PDF forms.
  • Minimize the risk of using outdated forms and eliminate rejected fillings.
  • Largest forms database in the USA with more than 80,000 federal, state and agency forms.
  • Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
  • Trusted by 1,000s of Attorneys and Legal Professionals

Description

BWC-1128 -- NOTICE TO CHANGE PHYSICIAN OF RECORD. This form is used by an injured worker to officially request a change in their treating physician for a workers' compensation claim. The injured worker provides details about their current and new physician, along with the reason for the change. The form must be submitted to the Managed Care Organization (MCO), which records the request and notifies the Bureau of Workers' Compensation (BWC). The MCO also ensures that only medical services related to the allowed conditions of the claim are billed appropriately. C-23. www.FormsWorkflow.com

Related forms

Our Products