Employee Referral for Medical Treatment

When an employee has an illness or injury during work, the following template can be presented to the Health Care Provider or Emergency Room in order to provide:

  • Basic information regarding the injured worker and the injury
  • Distribution information for bills and medical notes
  • Contact information for the organization’s contact person
  • Contact information for the claims adjuster
  • A form for reporting the employee’s diagnosis back to the organization

Download above.