Due Date: First Day of Class

While working in the hospital and on the ambulance as part of this course you are covered by COC's Worker's Compensation Program. That means if you get hurt during a clinical shift, COC will send you to a Worker's Compensation doctor and treat you for free, and cover your bills if you are treated in an emergency room. You can choose to be treated by your own doctor instead, but they must agree to it in advance by signing page 2 of the Designated Physician form. This must be done by Week 1 of the course.

Step 1
- Download and save the Pre-Designation of Personal Physician
Step 2
- Fill out page 1, including your address with city, state, and zip code
Step 3
- If you want to be treated by COC's Worker's Compensation doctors, you are finished with the form after page one - print it and add it to the checklist

If you want to use your own doctor:

Step 1
- Fill out page 2 of the form

- Take it your doctor to sign - they need to prove they are certified for Worker's Compensation cases
- This must be done by Week 1
- Print the form and use a paperclip to attach it to Checklist 1 in the order shown on the checklist