CHOICE OF PHYSICIAN FORM FOR ON-THE-JOB INJURIES  
  Pursuant to the Labor Code Sections 4600 and 4601, you may be treated by a physician of your choice from the 1st day of injury and thereafter; provided you have a personal physician and provided you have notified your employer of the name and address of this physician.  If you use Kaiser Health Plan, Takecare, Healthnet, or any other HMO, you may name the Health Care Plan as your physician.  If you wish to select both a chiropractor and a physician, you must notify your employer of the name and addresses of both. 

Forms are available at Local 315.  For an on-line form, please READ & acknowledge that you UNDERSTAND the following limitations and instructions:
 
1. If you do not complete and turn in this form, your employer has the choice of who treats you for the first 30 days after you are injured on the job.   Read & Understand
2. You must complete all information requested on the form.    Read & Understand
3. You must turn the form in to your supervisor, document his/her name on  your copy, and make a notation of the date it was filed.  KEEP A COPY FOR YOURSELF!  This is your proof.   Read & Understand

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