Tools & Documents for Workers

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Application for Supplemental Income (English)

Application for Supplemental Income Benefits

Type
PDF
Last Updated
2016-03-18

Authorization for Release of Protected Health Information

Authorization for release of protected health information (HIPAA compliant)

Type
PDF
Last Updated
2016-03-18

Common Workers' Comp Terms

Type
PDF
Last Updated
2016-08-11

Employee Request to Change Treating Doctor (English)

For use ONLY by Employees NOT in Workers’ Compensation Health Care Networks or Certain Political Subdivision Health Care Plans Type (or print in black ink) each item on this form

Type
PDF
Last Updated
2016-03-18

Employee Request to Change Treating Doctor (Spanish)

Para uso EXCLUSIVO de los Empleados que NO Participan en las Redes de Servicios Médicos de Compensación para Trabajadores o en Ciertos Planes de Salud de Subdivisiones Políticas Escriba a máquina (o a mano, usando tinta negra) cada artículo en este formulario

Type
PDF
Last Updated
2016-03-18

First Fill Program Pharmacy Card

Type
DOC
Last Updated
2016-06-14