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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.), doctor of osteopathic medicine (D.O.) or medical group. You must have designated your choice of service by first filling out this form by clicking here. Once you have filled out the form send it to risk management at firstname.lastname@example.org.
Welcome. Once you have completed the form, remove the last page and keep it for your own records. Next, turn the form in to your site Rep as soon as possible. click here.
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