NOTICE OF PERSONAL PHYSICIAN PRE-DESIGNATION

    A link to a copy of the pre-designation form is at the end of this document.  This form will be included in a "new member's packet" when  a new employee joins with Local 132.  I f you are currently a member and do not have a form on file and would like to, please contact the Union Office at 562-696-0142 or 1-877-788-6466 either by phone or by emailing at uwua@uwua132.org.

    This form must be filled out by yourself, as well as your doctor.  The doctor must sign and agree to be your primary treating physician.  You must elect a specific doctor at Kaiser, you cannot elect "Kaiser" as your pre-designated physician.  The doctor you choose must have treated you in the past and retain your medical records.

    You must pre-designate before you suffer a work related injury in order to treat with your doctor for the work related injury.  If you do not pre-designate, you must go to a company doctor for the first 30 days after the injury. 

    Any questions, feel free to contact Cheryl Wallace at Levy, Stern & Ford, 213-380-3140.

Click to see form: NOTICE OF PERSONAL PHYSICIAN PRE-DESIGNATION FORM