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:

• Bloomington
  Medical provider: IU Health Bloomington Occupational Services at 3443 West 3rd Street
• IUPUI
  Medical provider: IUPUI Health Services at Coleman Hall, 1140 W. Michigan St.

All other campuses

Download and print the Notification for Treatment form.

• Columbus
  Medical provider: Columbus Regional Occupational Health Physicians at 237 Washington Street, Columbus, IN 47201
• East
  Medical provider: Reid Hospital Occupational Medicine at 1100 Reid Parkway, Richmond, IN 47374

• Kokomo
  Medical provider: MedExpress Urgent Care at 1010 S Reed Road, Kokomo, IN 46901
• Northwest
  Medical provider: Comprehensive Care at 7501 15th Avenue, Gary, IN 46406
• South Bend
  Medical provider: Concentra Urgent Care at 19567 Cleveland Road, South Bend, IN 46637
• Southeast
  Medical provider: Norton Occupational Medicine at 3605 Northgate Court, Suite 110, New Albany, IN 47150