Concentra Authorization Form PDF Details

We hope you enjoy this blog post about the importance of using a Concentra Authorization Form. We will discuss what a Concentra Authorization Form is, how they help with patient care and how they can improve your hospital's effectiveness. A Concentra Authorization Form is a document that helps medical professionals better organize their work for patients coming in to be admitted. It helps them create an organized schedule for all aspects of the patient's stay from surgery to discharge, as well as foresee any problems before they happen and take steps to prevent them from happening at all. This reduces overall costs by ensuring everything goes smoothly without any delays or changes necessary which would incur extra cost later on if not prevented now.

The listing features information regarding the Concentra Authorization Form. It might be helpful to learn its size, the average time required to fill out the form, the blanks you'll have to fill in, etc.

Form NameConcentra Authorization Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesConcentra Employer Authorization Form, Concentra Authorization for Examination or Treatment Form

Form Preview Example

(Patient Must Present Photo ID at Time of Service)

Authorization for Examination or Treatment

Patient Name: ___________________________________________________

Social Security Number:___________________________________________

Employer: ___________________________________

Date of Birth: __________________________________________________

Street Address:___________________________________

Location Number: ___________________________________

Temporary Staffing Agency: ___________________________________

Work Related


Physical Examination


T Injury T Illness

T Preplacement

T Baseline

TAnnual T Exit

Date of Injury ___________________________________

DOT Physical Examination


Substance Abuse Testing+ (check all that apply)

T Preplacement

T Recertification

T Regulated drug screen T Breath alcohol

Special Examination


T Collection only

T Hair collect


T Respirator


T Non-regulated drug screen T Rapid drug screen

T Human Performance Evaluation+

T Other _________________


T Medical Surveillance

Type of Substance Abuse Testing

T Other _________________

T Preplacement

T Reasonable cause

Billing (check if applicable)


T Post-accident

T Random

T Employee to pay charges


T Follow-up






Special instructions/comments: _______________________________________________________________________________________________




Authorized by: ______________________________________________________

Please print

Phone: ( ___________________________________________________ ) ______________________________________________________________

+Due to the nature of these specific services, only the patient and staff are allowed in the testing/treatment area. Please alert your employee so that they can make arrangements for children or others that might otherwise be accompanying them to the medical center.

Title: ___________________________________________________________



Concentra now offers urgent care services for non-work related illness and injury. We accept many insurance plans.

(Copies of this form are available at

© 2008 Concentra Inc. All Rights Reserved. 06/08

How to Edit Concentra Authorization Form Online for Free

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Step 1: You can click the orange "Get Form Now" button at the top of this website page.

Step 2: At this point, you're on the file editing page. You may add information, edit current details, highlight certain words or phrases, put crosses or checks, add images, sign the file, erase unwanted fields, etc.

The PDF file you plan to prepare will consist of the following parts:

filling out Concentra Authorization Form part 1

Within the field cid Nonregulated drug screen, cid Rapid drug screen, cid Human Performance Evaluation, cid, cid Other, cid HAZMAT cid Medical Surveillance, Type of Substance Abuse Testing, cid Other, cid Preplacement cid Reasonable, Billing check if applicable, cid Postaccident, cid Random, cid Employee to pay charges, cid Followup, and Special instructionscomments type in the information that the program asks you to do.

Filling in Concentra Authorization Form step 2

Step 3: Once you choose the Done button, your ready form can be exported to all of your gadgets or to electronic mail chosen by you.

Step 4: Get a duplicate of every document. It may save you some time and make it easier to keep clear of troubles in the future. Also, your data isn't revealed or viewed by us.

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