Provider Search

To continue, please select an option below and then click on Create Worksite Poster.

To Continue, please select an option below, fill out all applicable fields and then click on Create Worksite Poster.

CHOOSE CLAIMS ADMINISTRATOR

	Create Panel – Zenith as Claims Administrator
	Create Panel – Other as Claims Administrator

Underwriting Carrier/Self-Insurer

Claims Administrator

Claims Administrator Address

Claims Administrator Phone

Pharmacy Provider

Physical Therapy Provider

Diagnostic Tests: MRI, CAT Scan, EMG

STARTING ADDRESS

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To continue, please enter the information in the entry fields below and then click on Create Worksite Poster.

TO BE COMPLETED BY THE EMPLOYER

Employer

Date of injury

Employer Contact

Phone

Email

SELECTED PROVIDER DETAILS

TO BE COMPLETED BY THE EMPLOYEE

I have selected the following physician from the list provided to me by my employer

Physician Name

Date Selected

Employee Name

Appt Date/Time

Address

City

State

Zip

Phone

Email

Date

To continue, please select an option below and then click on Create Directory.

	Create Directory – Zenith as Claims Administrator
	Create Directory – Other as Claim Administrator

Underwriting Carrier/Self-Insurer

Claims Administrator

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Provider Details

Location Details

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DRIVING DIRECTIONS

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TO BE COMPLETED BY THE EMPLOYER

SELECTED PROVIDER DETAILS

TO BE COMPLETED BY THE EMPLOYEE