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Form MEDCO-12 (BWC-3912) Request to Change Provider Information - Ohio
What Is Form MEDCO-12 (BWC-3912)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form MEDCO-12 (BWC-3912)?
A: Form MEDCO-12 (BWC-3912) is a request form used in Ohio to change provider information.
Q: Why would I need to use Form MEDCO-12 (BWC-3912)?
A: You would need to use Form MEDCO-12 (BWC-3912) if you are an injured worker in Ohio and need to change your provider information for workers' compensation.
Q: What information can I change using Form MEDCO-12 (BWC-3912)?
A: You can use Form MEDCO-12 (BWC-3912) to change your medical provider or to designate a new provider in Ohio for your workers' compensation claim.
Form Details:
- Released on July 1, 2020;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form MEDCO-12 (BWC-3912) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
