C-42 Form. Web written authorization may be revoked by grantor or grantee. Keep the completed form on file and send a copy to the employee for their records.
Repair Form
If you refuse to accept medical services from the chosen physician, your rights to benefits may be delayed. Web written authorization may be revoked by grantor or grantee. Keep the completed form on file and send a copy to the employee for their records. Alternative versions of the form are not allowed. Individuals may receive, review and correct information that twc collects about the individual by emailing to open.records@twc.state.tx.us. Web employee fill out the bottom portion of this form to indicate which physician you choose. Any business or employer that wants to grant an individual or service company.
Web written authorization may be revoked by grantor or grantee. Alternative versions of the form are not allowed. If you refuse to accept medical services from the chosen physician, your rights to benefits may be delayed. Any business or employer that wants to grant an individual or service company. Web employee fill out the bottom portion of this form to indicate which physician you choose. Web written authorization may be revoked by grantor or grantee. Individuals may receive, review and correct information that twc collects about the individual by emailing to open.records@twc.state.tx.us. Keep the completed form on file and send a copy to the employee for their records.
