Notice Of Personal Chiropractor Or Personal Acupuncturist {DWC 9783.1}

DWC FORM 9783.1 - NOTICE OF PERSONAL CHIROPRACTOR OR PERSONAL ACUPUNCTURIST. This is an optional California workers’ compensation form that allows an employee to designate a personal chiropractor or acupuncturist before any work-related injury occurs. If the employer does not use a Medical Provider Network (MPN), this advance notice may allow the injured worker to transfer treatment to their named provider after the claims administrator initially establishes care. The form explains statutory limits, including the 24-visit cap for chiropractic treatment for injuries on or after January 1, 2004, unless the employer authorizes additional visits. Employees list the provider’s name, address, and phone number, and sign the form to notify the employer in writing of their designation. www.FormsWorkflow.com