Injured Worker Information Consent Form

Information consent form from company to treating professionals

Injured Worker Information Consent Form

While handling confidential health and personal information about a worker’s work-related injury, there are some legal actions that an employer needs to take. By law, consent from a worker is required to exchange and receive information regarding their health, injury, and recovery. This process promotes good communication and helps to reduce emotional distress and hasten recovery while improving long-term outcomes. Information consent form is used to collect all the relevant information and to grant the permission of the worker for the release and exchange of information. You must ensure that the worker understands the benefits of providing consent and risks.

What to include on the form?

When a worker is injured in the workplace, he/she must be given prompt medical attention. To disclose and share any medical or injury related information of the employee, the employer needs consent from the worker. An injured worker information consent form is a formal approach to grant the worker’s permission to get the required injury-related information.

The form must include the statement that the worker is authorizing the employer to obtain information regarding the Injury management. Include the details of a doctor, the name of the hospital, rehabilitation provider, union and other relevant information. The form must state that the information provided will be of a factual nature about injury management.

• Name of the injured worker
• Name of the doctor providing the treatment
• Name of the hospital
• Rehabilitation Provider
• Union
• Worker’s Solicitor
• Employment Service
• Other
• Date
• Signature

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