Employer Notification for Treatment Form

Electronic notification for Bloomington and IUPUI campuses

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To access use your IU Network ID user name and passphrase:

• Bloomington
  Medical provider: IU Health Occupational Services (East) at 323 S. Woodcrest
• IUPUI
  Medical provider: IUPUI Health Services at Coleman Hall, 1140 W. Michigan St.

 

All other campuses

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Download and print PDF of Notification for Treatment form:

• East
  Medical provider: Reid Hospital Occupational Medicine, 1100 Reid Parkway Richmond, IN 47374

• Kokomo
  Medical provider: Howard Regional Health at 3500 S. Lafountain St.
  Please enter through the Community Primary care entrance
• Northwest
  Medical provider: Immediate Care Center 5521 W. Lincoln Hwy Suite 1A, Crown Pointe, IN 46307
• South Bend
  Medical provider: Bittersweet Medical Associates 12340 Bittersweet Commons W. Blvd, Granger, IN 46530
• Southeast
  Medical provider: Occupational Medicine Physicians at 3605 Northgate Court, Ste. 110