Tools & Documents for Workers
Application for Supplemental Income (English)
Application for Supplemental Income Benefits
- Type
- Last Updated
- 2023-07-26
Application for Supplemental Income (Spanish)
- Type
- Last Updated
- 2023-07-26
Authorization for Release of Protected Health Information
Authorization for release of protected health information (HIPAA compliant)
- Type
- Last Updated
- 2023-07-26
Common Workers' Comp Terms
- Type
- Last Updated
- 2023-07-26
Employee Request to Change Treating Doctor (English)
For use ONLY by Employees NOT in Workers’ Compensation Health Care Networks or Certain Political Subdivision Health Care Plans Type (or print in black ink) each item on this form
- Type
- Last Updated
- 2023-07-26
Employee Request to Change Treating Doctor (Spanish)
Para uso EXCLUSIVO de los Empleados que NO Participan en las Redes de Servicios Médicos de Compensación para Trabajadores o en Ciertos Planes de Salud de Subdivisiones Políticas Escriba a máquina (o a mano, usando tinta negra) cada artículo en este formulario
- Type
- Last Updated
- 2023-07-26
First Fill Program Pharmacy Card
- Type
- DOC
- Last Updated
- 2023-07-26
Injured Employee Rights and Responsibilities
- Type
- Last Updated
- 2023-07-26
Request for Travel Reimbursement (English and Spanish)
- Type
- Last Updated
- 2023-07-26
Texas Department of Insurance
- Type
- Link