Physician Pre-Designation

Employees have the option of pre-designating their personal physician as their treating physician in the event of a work-related injury/illness. This designation must occur prior to a work-related injury/illness and your physician must agree to be pre-designated. Employees bear the responsibility of keeping their physician pre-designation current with the Workers' Compensation Coordinator.

Note: A personal physician includes a medical group, if the medical group is composed of licensed doctors of medicine or osteopathy operating as a multi-specialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries (e.g. Kaiser Permanente). A specialist or specialty group, such as an orthopedist, cannot be pre-designated.

• Personal Physician Pre-Designation Forms

  Download the form, enter your name, sign and date before providing to your personal physician to complete the remaining fields on the form.

  If physician is either a M.D or D.O
  If physician is either a Chiropractor or an Acupuncturist

• How to Submit Your Personal Physician Pre-Designation Form

  Submit your completed form to the Office of Human Resources via one of the following methods:

  • Secure fax to (833-536-1793)
  • MoveIt, campus credential required: California State University (calstate.edu)
  • Encrypted Email by entering “csusm-encrypt” in the subject line using your csusm email address
  • Sealed inter-office mail (marked as confidential)
  • In-person to the Office of Human Resources – Administrative Bldg, ste. 4800
  • Mail to: California State University San Marcos, ATTN: Workers’ Compensation Coordinator, 333 S. Twin Oaks Valley Road, San Marcos, CA 92096-0001