Please read the following information concerning pre-designating a treating physician for a work-related injury or illness.  Even if you have already completed a “pre-designated” form you may have to complete a new form.

The new pre-designated form.

NOTICE TO ALL EMPLOYEES REGARDING PREDESIGNATED PHYSICIAN FOR WORK RELATED INJURIES OR ILLNESSES

In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness by your personal Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.).  The predesignated physician must be your regular physician who has limited his or her practice of medicine to general practice or who is board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist or family practitioner, and has previously directed your medical treatment and retains your medical records.

Due to changes in legislation, you must complete a new form (located on DHR’s Risk Management intranet site) if you wish to continue to predesignate your personal physician to treat you if you are injured on the job.  If you currently predesignate and wish to continue, you must submit a completed form no later than May 1, 2007.  If you do not submit a new predesignated physician form and you sustain an injury on the job you will be treated through the County’s designated medical provider.

The most significant change in legislation is that your doctor must agree to be predesignated to treat you for work related injuries or illnesses.  The attached form includes a signature line for your doctor or designated assistant to sign confirming that he or she agrees to treat you for a work related injury or illness.  The form must be completed prior to the injury in order to be allowed to treat with your doctor. 

If you have questions, please contact the Medical Liaison Unit at 858/974-2032.  Please send your completed form to the Medical Liaison Unit at MS 041. 

The new pre-designated form online, or it can be found on the Sheriff’s intranet, under HR, Risk Management, Forms.