WebDECLINATION OF WORKERS’ COMPENSATION BENEFITS (MEDICAL TREATMENT) I, understand that I am entitled to Workers’ (employee) Compensation benefits, examination … WebAcknowledgement and Declination to Receive Medical Treatment . It is a crime to knowingly provide false, incomplete or misleading information to any party to an on the job injury …

State of California—Health and Human Services Agency …

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Declination of Medical Treatment - Previsor Insurance

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