SUBJECT:

Medical Treatment Policy for Workers' Compensation Injuries

Effective September 1, 1994, UCSD employees sustaining a work-related
injury or illness should obtain initial medical treatment at either the
Thornton Hospital ER/Urgent Care or the UCSD Medical Center ER.

Employees wishing to be treated by their personal physician or by
another health care provider for the entire injury period, MUST FILE A
WRITTEN NOTICE WITH THEIR DEPARTMENT PRIOR TO THE INJURY. Attached is
a DESIGNATION OF PHYSICIAN FORM that may be completed by employees
wishing to designate a treating doctor in the event of a work-related
injury or illness. Since only one form is attached, please keep it as
an original and make photocopies to service all employees in your
department. If an employee already has a form on file, a new form is
not required unless the employee wants to update the information. The
completed form should be kept in the employee's departmental personnel
file for future reference.

If you have any questions about this new policy, please call the
Workers' Compensation Office at any of the following numbers:
534-0136, 534-4785 or 534-2092.

Van Jahnes-Smith Manager

Attachment

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DEPARTMENT:________________________________________________________

In the event I have a job-related injury or illness, I request
treatment by the following licensed physician/HMO or chiropractor:

DOCTOR'S NAME:___________________________________________________

DOCTOR'S ADDRESS OR HMO FACILITY:________________________________

___________________________________________________________________

DOCTOR'S TELEPHONE NUMBER:______________________________________

SIGNATURE OF EMPLOYEE:___________________________________________

DATE FORM WAS COMPLETED:________________________________________

IMPORTANT: This form must be returned to your supervisor and placed
in your departmental personnel file to complete your physician
designation.

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  MEDICAL TREATMENT FOR UCSD WORKERS' COMPENSATION INJURIES

Prompt medical care is a key element for a fast recovery from an injury
or illness. Quality emergency medical care and follow-up treatment can
often mean the difference between complete recovery from an injury or
illness, or lasting physical disability. If you are injured at work,
report the injury immediately to your supervisor, who will direct you to
the UCSD Medical Center Emergency Room or the Thornton Hospital
Emergency Room/Urgent Care.

Employees wishing to be treated by their personal physician for the
entire period of a work-related injury or illness may file a
DESIGNATION OF PHYSICIAN FORM with their department. The form must be
completed prior to the injury and be in the employee's departmental
personnel file. If you do not file a DESIGNATION OF PHYSICIAN FORM,
your initial medical care for a work-related injury or illness will be
directed by UCSD.

If you have any questions regarding this form, please call the
Workers' Compensation Office at the following numbers: 534-0136,
534-4785, 534-2092.

REV. 8/94