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Occupational Health: For Employers

Important Forms and Service Information
Home » Services » Occupational Health » Cameron Occupational Health Employer Forms

Occupational Health Information for Employers

To better serve you and your employees, please fill out the below authorization forms prior to your employee’s visit.

Please complete both forms within your browser. Alternatively, you may download the forms as PDF documents and return them using any of the following methods:

  1. Send both pages of the completed form with your employee (preferred method to avoid delays)
  2. Fax both pages of the completed form to 260-667-5630
  3. Email both pages of completed form to occhealth@cameronmch.com

Cameron Hospital Medical Authorization Form

Cameron Hospital Medical Authorization Form
Click to Expand Form

Occupational Health Medical Authorization

  • Pre-Hire / Post-Offer

  • Injury Treatment

  • Post-Accident (Non-Injury/Property Damage)

  • Reasonable Suspicion/Probable Cause

  • Random Services

  • Annual Services/Screening

  • Return to Work Services

  • Other

Cameron Hospital Occupational Health Company Protocol

Cameron Hospital Occupational Health Company Protocol
Click to Expand Form

Occupational Health Company Protocol

  • Billing Information

  • Clinical Information

  • Drug Screen Results

  • BAT Results

Treatment Process

Our staff will provide the services on the completed authorization form

If no authorization is provided, our staff will treat by following the company account, previously established with your Business Development Specialist.

If services requested are not listed on your account, we will make an attempt to call your company for authorization of services to be performed. (This may cause delays for employee)

Our Occupational Health Services

We offer a variety of programs to help your employees make healthier lifestyle choices. Backed by evidence-based medicine and tested clinical protocols, these programs are designed to help employees break from unhealthy habits and replace them with new, healthy ones. Your employees will become more accountable for their health — and become healthier and more engaged in the workplace.

For more information about Cameron Hospital’s occupational health services, contact our offices today.

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