Resource Browser
| Filename | Description | Updated | |
|---|---|---|---|
| 1E-Take to Doctor | Injured Employee: Take this form to your doctor. It includes instructions and authorization for workers compensation. | ||
| 2E-Doctor Choice Form | Doctor Choice Form 50 - Nebraska. This form is required for workers' compensation injuries fax to 402-715-1097 or e-mail the completed form to fmla-wc@mpsomaha.org. Workers compensation |
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| 3E-Employee Work Comp - Follow-up Form | Download the form to your desktop to complete the form. Workers Compensation Forms: Employee Follow-up Form to provide to your supervisor after each doctor visit. | ||
| 3E-Employee Work Comp - Follow-up Form | Workers Compensation Forms: Employee Follow-up Form to provide to your supervisor after each doctor visit. MAC Version |
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| 4E - First Fill Prescription Form | Injured Employee: Get your workers' compensation prescriptions filled. English & Spanish Version |
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| Employee Flow Chart for Workers Compensation Injuries | Step by step Instructions if you are injured at work | ||
| Rights & Obligations | Workers Compensation Information Sheet | ||
| Rights & Obligations (Spanish) | Workers Compensation Information Sheet (Spanish) |