University Human Resources
Employer Notification for Treatment Form
Electronic notification for Bloomington and IUPUI campuses
To access use your IU Network ID user name and passphrase:
Medical provider: IU Health Occupational Services (East) at 323 S. Woodcrest
Medical provider: IUPUI Health Services at Coleman Hall, 1140 W. Michigan St.
All other campuses
Download and print PDF of Notification for Treatment form:
Medical provider: Reid Hospital Occupational Medicine, 1100 Reid Parkway Richmond, IN 47374
Medical provider: Howard Regional Health at 3500 S. Lafountain St.
Please enter through the Community Primary care entrance
Medical provider: Immediate Care Center 5521 W. Lincoln Hwy Suite 1A, Crown Pointe, IN 46307
- South Bend
Medical provider: Bittersweet Medical Associates 12340 Bittersweet Commons W. Blvd, Granger, IN 46530
Medical provider: Occupational Medicine Physicians at 3605 Northgate Court, Ste. 110