Employer Notification for Treatment Form
Authorize the initial medical appointment.
Electronic notification for Bloomington and IUPUI campuses
To access use your IU Network ID user name and passphrase:
Medical provider: IU Health Bloomington Occupational Services at 3443 West 3rd Street
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: Columbus Regional Occupational Health Physicians at 237 Washington Street, Columbus, IN 47201
Medical provider: Reid Hospital Occupational Medicine at 1100 Reid Parkway, Richmond, IN 47374
Medical provider: MedExpress Urgent Care at 1010 S Reed Road, Kokomo, IN 46901
Medical provider: Comprehensive Care at 7501 15th Avenue, Gary, IN 46406
- South Bend
Medical provider: US HealthWorks (formerly Wipperman Occupational Health) at 19567 Cleveland Road, South Bend, IN 46637
Medical provider: Norton Occupational Medicine at 3605 Northgate Court, Suite 110, New Albany, IN 47150