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Get Supervisors Authorization Fill 2017-2025

515.2151 (phone) 888-317-2890 (fax) Workerscomp ncsu.edu Supervisor: Please complete Section A and give to the injured employee to take with them to the authorized treating medical provider. This form authorizes their initial care. The required workers compensation paperwork is to be delivered to HR Benefits/University Claim Service within 24 hours from the notice of the alleged injury/disease. Section A: Patient Information Name of Employee: Last: First: (9 digit) Date of Injury: Employee ID.

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