Employer Notification for Treatment Form

Authorizing the initial medical appointment

If you are injured on the job and seeking treatment, it is important that your supervisor completes and submits the Employer Notification for Treatment Form. It lets the medical team know that your initial visit is covered by workers’ compensation.

Electronic notification for the Bloomington and Indianapolis campuses

To access use your IU Network ID user name and passphrase:

• Access the IU Bloomington form
  Medical provider: IU Health Bloomington Occupational Services at 482 S. Liberty Drive
• Access the IU Indianapolis form
  Medical provider: IUI Campus Health at Lockefield Village, 1st floor, 980 Indiana Ave.