C-42 Form. Alternative versions of the form are not allowed. If you refuse to accept medical services from the chosen physician, your rights to benefits may be delayed.
Repair Form
Web written authorization may be revoked by grantor or grantee. Web employee fill out the bottom portion of this form to indicate which physician you choose. Any business or employer that wants to grant an individual or service company. Individuals may receive, review and correct information that twc collects about the individual by emailing to open.records@twc.state.tx.us. Alternative versions of the form are not allowed. If you refuse to accept medical services from the chosen physician, your rights to benefits may be delayed. Keep the completed form on file and send a copy to the employee for their records.
Keep the completed form on file and send a copy to the employee for their records. Web written authorization may be revoked by grantor or grantee. Alternative versions of the form are not allowed. Any business or employer that wants to grant an individual or service company. Web employee fill out the bottom portion of this form to indicate which physician you choose. Keep the completed form on file and send a copy to the employee for their records. If you refuse to accept medical services from the chosen physician, your rights to benefits may be delayed. Individuals may receive, review and correct information that twc collects about the individual by emailing to open.records@twc.state.tx.us.
