|OhioBWC - Provider - Form: (C-9) - Introduction|
|Physician's Request for Medical Service or
Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9)
|Medical providers use this form to supply information to managed care organizations (MCOs) or self-insuring employers and to request authorization for additional treatment. Information includes: the current diagnosis, additional conditions felt to be related to the industrial accident/exposure and causal relationship of conditions to the accident/exposure. If a physician requests additional treatment, he/she must indicate the specific type, frequency and duration of the treatment.|
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