Treatment Authorization

We are authorizing the below listed U.S. HealthWorks(s) to provide treatment to our employees. By doing so, we acknowledge that if the claim is denied by our insurance carrier, we will notify USHW of the denial and will be responsible for payment for all services rendered and any medically-necessary items dispensed.
This authorization will be valid for up to 72 hours from time of submission. Please send employee into the clinic within the valid timeframe. If the employee presents to the clinic after the 72 hours has expired, additional authorization may be requested by U.S. HealthWorks.
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