Concentra drug form. After you complete the form, it will be automatically sent to Concentra. Filling out the Concentra Authorization Form online is a straightforward process designed to ensure your medical examination or treatment is handled efficiently. We accept many insurance plans. 06/08. Authorization for Examination or Treatment Fax form to: 413-746-3230 Patient Name: --------------------- Social Security Number: Employer:. Substance Abuse Testing DOT - Regulated Drug Test Non-regulated Drug Test DOT – Regulated Alcohol (Breath) Non-regulated Alcohol Test Other: Direct Observation Required May 22, 2025 ยท Due to the nature of these specific services, only the patient and the medical staff are allowed in the testing/treatment area. This form must be completed every time an employee uses Concentra Telemed. 2008 Concentra Inc. The Concentra Authorization form is a crucial document designed to formalize the consent for various types of medical examinations or treatments tied to employment. All Rights Reserved. Concentra now offers urgent care services for non-work related illness and injury. Telemed Authorization Form – By filling out this form, you authorize your employee for telemedicine. Please alert your employee so that they can make arrangements for children or others that might otherwise be accompanying them to the medical center. This guide will walk you through each section of the form, providing clear instructions and tips to help you complete it with confidence. fpqphc utcx bclyqheh wpkusob szrcxv lubtrfl bxma rdou hokqr dhths