wor k e r s ’ c om p e n s at i on e m p l oye e i n s t r

255 Pico Ave. Ste. 250 San Marcos, CA 92069

Employee Instructions for Work Related Injuries Workers’ Compensation

255 Pico Ave. Ste. 250, San Marcos, CA 92069

A safe working environment is our number one priority. However, should an accident or injury occur we want to ensure that San Marcos Unified School District employees receive prompt, effective medical treatment.

IF YOU ARE INJURED AT WORK: 1. Immediately notify your supervisor and report the injury. (Report the injury even if you are not seeking treatment at this

time.) 2. If you decide to decline medical treatment, please fill out the Declination of Medical Treatment form provided by your

supervisor or Risk Management. Completing and submitting this form does not waive your rights to workers’ compensation.

3. Your Supervisor will complete the Supervisor’s Report of Accident form and ask you to complete the following forms in this packet. Once filled out please send it to your Supervisor and [email protected] as soon as possible.

● Injured Employee’s Responsibilities ● Certification of Outside Employment ● DWC-1 Claim Form

4. If medical treatment is needed, you will be provided with an authorization form and directed to Concentra (the District’s provider) for your industrial injury, unless the appropriate Predesignation of Personal Physician form is on file in the Human Resources Department prior to the injury.

● If medical care is needed and your supervisor is not available, report your injury immediately to Risk Management. You will be given an authorization for treatment at Concentra.

If your injury requires non-urgent medical attention and you do not have a Predesignated of Personal Physician, your initial treatment and appointment will be at Concentra. You can be treated by your own personal physician if a predesignation form was completed prior to the date of injury.

You will need authorization to visit: 1. Concentra, 740 Nordahl Rd., Suite 131, San Marcos, CA 92069, 760-432-9000 (8 AM-8 PM) 2. 24-hour Concentra, 5575 Ruffin Rd, Ste 100, San Diego, CA 92123

APPOINTMENTS: If you cannot keep an appointment, please contact the Risk Management office. Missed appointments may result in loss of benefits and your ability to participate in the Return-to-Work Program. All appointments should be scheduled outside of working hours after initial treatment. The District understands that it may be difficult for full-time employees to schedule industrial injury related appointments outside of their work hours. The District allows these employees to use industrial accident leave for these rare occasions and for reasonable travel to and from the appointments. If you opt not to return back to work, then you are to obtain authorization from your supervisor for the remainder of time missed. The time will then be appropriately docked from personal time rather than industrial accident leave.

Revised June 2021

WHEN A WORK-RELATED INJURY OCCURS

WHAT DOCTOR DO I GO TO?

mailto:[email protected]

Any use of sick leave is subject to all District policies, procedures and rules as stated in your contract, and it is your responsibility to ensure compliance.

KEEP RISK MANAGEMENT AND YOUR SUPERVISOR INFORMED: It is your responsibility to provide a copy of your work status to Risk Management immediately following every doctor visit. In addition, you need to provide a copy of the work status to your supervisor. If you are given work restrictions by your physician, they should clearly state what your limitations are, including any recommended change in your normal schedule. Be certain you understand these limitations and they are clearly written on your status report provided to Risk Management.

Athens Administration is the District’s Third Party Administrator. All injured employees will receive correspondence from Athens after their workers’ compensation claim is submitted by the District. This correspondence will have the claims adjuster’s contact information. A pharmacy card will also be sent to your home address to cover any pharmaceutical medication prescribed. Please do not use your personal medical benefits.

MILEAGE REIMBURSEMENT Once your claim is accepted by Athens, your mileage to and from appointments affiliated with your industrial accident is reimbursable through Athens. Please keep track of your mileage. You will need to document the date, address to and from, and the number of miles traveled. A mileage reimbursement form will be provided by Athens in the packet they will send to your home address. These forms will need to be returned directly to Athens.

RETURN-TO-WORK PROGRAM: Per Board Policy/Administrative Procedure 4113.4, San Marcos Unified School District has established a Return-to-Work program for employees who have been released by their treating physician with temporary work restrictions. “Participation is mandatory for those employees who meet the program requirements. Employees who refuse transitional work may not be eligible for workers’ compensation disability benefits (per California Labor Code) and may also be subject to disciplinary action.

The employee will enter the program formally within a three (3) day waiting period following the District’s receipt of a medical release to return to work. If an employee has been released to return to work with work restrictions during the three-day waiting period, Risk Management will work with the employee and the employee’s supervisor to explore the possibility of modifications. The employee may remain in the program for a maximum of 120 calendar days. ”

Transitional modified/alternate duties and/or changes in your work schedule require approval. The process is outlined below:

● Provide Risk Management with your treating physician’s work status specifying your restrictions. ● Risk Management will work with your supervisor and Human Resources to evaluate if modified duty within

your position is available or if you will be placed in an alternate position on a temporary basis, if feasible. ● You will be notified of the work options available to you. ● Transitional modified/alternate duties will be terminated and you will be placed off work if one of the

following occurs: ○ Your physician places you on a temporary disability status. ○ Your work restrictions can no longer be accommodated. ○ After working 120 calendar days of a transitional return-to-work assignment, the employee continues to

Revised June 2021

THIRD PARTY ADMINISTRATOR

COMPONENTS OF WORKERS’ COMPENSATION

require work restriction accommodations. ○ You do not follow all the medical directives of your treating physician.

“Workers’ compensation fraud is a felony -anyone who knowingly files or assists in the filing of a false workers’ compensation claim may be fined up to $50,000 and sent to prison for up to five years (Insurance Code section 1871.4).”

MEDICAL TREATMENT: All services requested by the treating physician beyond the initial visit must , by law (SB899), go through Utilization Review (UR). Timely filing of employee and supervisor reports is beneficial to the UR process. All UR approvals are set by certain medical standards (ACOEM) and are not a guarantee that requested services will be approved. Any questions regarding your treatment or a medical referral, please contact your claims examiner at Athens.

EXTENDED HOURS/EXTRA DUTY/OVERTIME While work restrictions are being accommodated by the District, we are unable to permit you work extended hours, extra duty or overtime hours, such as summer school. Please rest, recover and heal.

WORKERS’ COMPENSATION LEAVE ● Industrial Leave:

Education Code Section 44984/87787 (certificated) and 45192/88192 (classified) provide that an employee who is injured on the job or is sick as a result of working conditions, will receive 60 days of Industrial Accident Leave.

● Docked Sick Leave: Once you exhaust the 60 days of Industrial Accident Leave, your sick time is docked by 1/3rd of day and 2/3rd of your pay will be compensated under workers’ compensation.

● 100 Days/5 Month Differential Leave: Once you exhaust your sick leave, you will begin your entitled 100 days/5 months of differential pay. Certificated Staff - Differential pay is calculated as your daily rate minus the cost of a substitute. Classified Staff - Differential pay is calculated at 50% of your pay.

● 39-Month Rehire List:

Once all leave has been exhausted, you will be placed on a rehire list for 39 months.

● FMLA Leave: FMLA Leave will run concurrently, if you are eligible, during consecutive absence for your industrial injury.

Mareesa Evans - Risk Management Coordinator [email protected] Direct # (760) 290-2360 Cell # (760) 566-4051

Kyle Azcuna - Risk Management Supervisor [email protected] Direct # (760) 290-2388 Cell # (760) 525-1448

Audrey Hotaling - Risk Management Supervisor [email protected] Direct # (760) 290-2387 Cell# (760) 415-1083

Revised June 2021

QUESTIONS: CONTACT RISK MANAGEMENT AT [email protected]




SAN MARCOS UNIFIED SCHOOL DISTRICT INJURED EMPLOYEE’S RESPONSIBILITIES

San Marcos Unified School District is committed to providing injured employees with excellent medical treatment and support during the course of treatment. Please contact the Risk Management Team with questions or concerns regarding your industrial injury . [email protected]

To ensure a swift recovery and return to work, injured employees are responsible for cooperating with the Risk Management Office. Risk Management should be notified immediately after a work-related injury. The District will not be responsible for any self-procured medical treatment that is not in the Medical Provider Network. It is expected that all injured employees comply with physician recommendations and direction. Your personal medical insurance will not cover treatment for industrial injury or illness unless a Predesignation of Personal Physician form is on file with Human Resources prior to your injury.

Temporarily Totally Disabled means the doctor has determined you are totally disabled on a temporary basis and unable to perform any work including modified duty. If you are declared Temporarily Totally Disabled (TTD) or given work restrictions by your treating physician, it is imperative and expected that you will adhere to the work restrictions at all times while at work or outside of work including weekends, holidays, summer, home, etc.

It is your responsibility to provide a copy of your work status to Risk Management immediately following every doctor visit. In addition, you need to provide a copy of the work status to your supervisor. If you are given work restrictions by your physician, they should clearly state what your limitations are, including any recommended change in your normal schedule. Be certain you understand these limitations and they are clearly written on your status report provided to Risk Management.

If you cannot keep an appointment, please contact the Risk Management office. Missed appointments may result in loss of benefits and your ability to participate in the Return-to-Work Program. All appointments should be scheduled outside of working hours after initial treatment. The District understands that it may be difficult for full time employees to schedule industrial injury related appointments outside of their work hours. The District allows these employees to use industrial accident leave for these rare occasions and for reasonable travel to and from the appointments. If you opt not to return back to work, then you are to obtain authorization from your supervisor for the remainder of time missed. The time will then be appropriately docked from personal time rather than industrial accident leave.

By Signing below, I acknowledge that I have reviewed the “Employee Instructions for Work Related Injuries” and the “Injured Employee’s Responsibility” form. I further understand that it is my responsibility to make myself familiar and to adhere to the District’s procedures outlined in both of these documents.

___________________________________________ _______________________________________ ________________ Employee Name (Please Print) Employee Signature Date

*Any evident or misrepresentation, suspicion of fraud, or abuse of workers’ compensation benefits is illegal. “Workers’ compensation fraud is a felony - anyone who knowingly files or assists in the filing of a false workers’ compensation claim may be fined up to $50,000 and sent to prison for up to five years (Insurance Code section 1871.4).”

Revised June 2021

SAN MARCOS UNIFIED COMMITMENT

EMPLOYEE RESPONSIBILITIES

SAN MARCOS UNIFIED SCHOOL DISTRICT

CERTIFICATION OF OUTSIDE EMPLOYMENT

Name: Date of Injury:

INSTRUCTIONS:

1. Please document all current and previous (within the last 12 months) employment outside San Marcos Unified

School District whether paid or unpaid.

2. Include work done for family or friends or self‐employment (having or starting your own business).

3. Please include unpaid volunteer work (denote as “Volunteer”).

4. Use a separate form for each outside employer.

5. Please include all pending employment, pending volunteer work, or any business you are considering starting.

6. Complete Part A if you have had no outside work activity OR complete Part B if you have outside work activity.

Do not complete both sections

Part B

Outside Employer’s Name: Outside Employer’s Address: Outside Employer’s Telephone: Outside Employer Supervisor: Outside Employer’s Workers’ Compensation Insurance: Type of outside employment and duties:

Number of hours per week you work this outside job: How long have you worked in this outside job: I understand and agree that San Marcos Unified School District is not liable for any damages, injuries or illnesses in‐ curred through my outside employment/volunteer work. I agree to inform the SMUSD Risk Management Workers’ Compensation Office immediately if my outside employment or volunteer activities change at any time throughout the course of my workers’ compensation claim with SMUSD. My signature below confirms that the above statement under penalty of perjury is true and complete to the best of my knowledge.

Employee Signature Date Signed

20

Part A

I have no employment/volunteer work as defined above other than my position with San Marcos Unified School Dis‐

trict. I agree to keep the SMUSD Risk Management informed if my outside employment or volunteer activities change

throughout the course of my workers’ compensation claim with SMUSD. My signature below confirms that the above

statement under penalty of perjury is true and complete to the best of my knowledge.

Employee Signature Date Signed

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©2018 Concentra Operating Corporation 04/18

www.concentra.com

• Work-related injuries receive immediate triage assessment.

• Pre-placement and DOT exam forms are provided, or you may use other DOT approved MER and/or MEC forms.

• No contract is required when working with Concentra. Our fees are competitive and adhere to the applicable state workers’ compensation fee guidelines.

• Visit concentra.com/our-locations for a list of locations and driving directions.

San Diego Locations

C7620Map1_11x17

15

5

5

8

805

805

15

15

5

163

125

78

78

56

675252

94

54

75

El Camino Real

West Valley Parkway

Santee

Carlsbad

Oceanside

SanMarcos

Escondido

Chula Vista

National City

La Mesa

San Diego

Approximately 35 miles North on I-15Murrieta

Mission Valley

Nor

dahl

Rd

Montiel Rd

Friars Rd

Miss

ion

Cent

er R

d

1

2

3

4

5

6

7

8

9

10

11

12

13

14

North County

ConcentraConcentra San Marcos

740 Nordahl Rd.Suite 131

San Marcos, CA 92069760.432.9000

Mon - Fri: 8 am - 8 pmSat - Sun: 8 am - 5 pm

Concentra San Marcos740 Nordahl Rd.

Suite 131San Marcos, CA 92069

760.432.9000

Lun - Viér: 8 am - 8 pmSáb - Dom: 8 am - 5 pm

*Opening Jan. 2013

HeaderAddressCity, State ZipP Phone#

HeaderAddressCity, State ZipPhone#

HeaderAddress

City, State ZipP Phone#

F Fax#



740 Nordahl Rd., Suite 131

San Marcos, CA 92069

740 Nordahl Rd., Suite 131




760.432.9000760.741.0746

740 Nordahl Rd., Suite 131San Marcos, CA 92069

760.432.9000Fax: 760.741.0746


760.432.9000Fax: 760.741.0746

740 Nordahl Rd.Suite 131San Marcos, CA 92069

740 Nordahl Rd.Suite 131San Marcos, CA 92069




Concentra San Marcos740 Nordahl Rd., Suite 131

San Marcos, CA 92069Mon - Fri: 8 am - 8 pmSat - Sun: 8 am - 5 pm

760.432.9000Fax: 760.741.0746


San Marcos, CA 92069Lun - Viér: 8 am - 8 pmSáb - Dom: 8 am - 5 pm

760.432.9000Fax: 760.741.0746

Concentra San Marcos740 Nordahl Rd., Suite 131San Marcos, CA 92069760.432.9000Fax: 760.741.0746


San Marcos, CA 92069760.432.9000

Fax: 760.741.0746




Concentra San Marcos740 Nordahl Road, Ste. 131San Marcos, CA 92069760.432.9000Fax: 760.741.0746

Concentra San Marcos740 Nordahl Road, Ste. 131San Marcos, CA 92069760.432.9000Fax: 760.741.0746

Concentra San Marcos740 Nordahl Rd., Suite 131San Marcos, CA 92069760.432.9000

740 Nordahl Rd., Suite 131, San Marcos, CA 92069 760.432.9000 Fax: 760.741.0746

San Marcos740 Nordahl Rd, Ste 131San Marcos, CA 92069Mon-Fri: 8 am - 8 pmSat-Sun: 8 am - 5 pmPh: 760.432.9000Fx: 760.741.0746

5. San Marcos740 Nordahl Rd, Ste 131San Marcos, CA 92069Lun-Viér: 8 am - 8 pmSáb-Dom: 8 am - 5 pmPh: 760.432.9000Fx: 760.741.0746

5.

740 Nordahl Rd., Suite 131San Marcos, CA 92069760.432.9000

San Marcos740 Nordahl Rd, Ste 131San Marcos, CA 92069Mon-Fri: 8 am - 8 pmSat-Sun: 8 am - 5 pmPh: 760.432.9000Fx: 760.741.074

San Marcos740 Nordahl Rd, Ste 131San Marcos, CA 92069Lun-Viér: 8 am - 8 pmSáb-Dom: 8 am - 5 pmPh: 760.432.9000Fx: 760.741.074

RegularLetterhead

Brochure- Syntax 9 pt1 Location

English Spanish WinWin Flyer- Syntax DOCTORLetter

Brochure- Syntax 7 ptMulti Location

Physical Therapy FrontMyriad Pro 12 pt

Respirator CardArial 8 pt

Appointment CardsArial 7 pt

AMSReferral Postcard

EmpostEnglish

EmpostSpanish

UCF1-4 Locations

UCF 12pt1-4 Locations

Travel Health 1 panel Insert

Travel Health Brochure(CONTH_BRO)

Tricare Bro (CON_PTTRI)

Travel Health Goto card

Travel Health Postcard (CONTH_PC)

Rx PadRight Aligned

ENVRegular & AMS (Spot)

ENVRegular (Black)

CMCXRay Card

BlackLabel

ENV (Monarch)AMS

XRay CardENV

Prints on Back Flap

2 Color Label

ENV (Monarch)Black

Rx PadCentered

Teaser- Syntax 7 pt Bill Stuffer- Syntax 12 pt

ENG MagnetsSyntax LT Std

SPAN MagnetsSyntax LT Std

ER TABLET

Best In Class Care Brochure(BICOM_BRO)

Concentra

25115 Madison AveMurrieta, CA 92562951.600.9070

25115 Madison Ave

Murrieta, CA 92562

25115 Madison Ave

Murrieta, CA 92562

25115 Madison AveMurrieta, CA 92562

951.600.9070951.600.9177


951.600.9070Fax: 951.600.9177


951.600.9070Fax: 951.600.9177







CONCENTRA MEDICAL CENTER25115 Madison Ave, Murrieta, CA 92562

AMS25115 Madison Ave, Murrieta, CA 92562

Murrieta25115 Madison AveMurrieta, CA 92562951.600.9070Fax: 951.600.9177

MURRIETA

25115 MADISON AVE

MURRIETA, CA 92562

(951) 600-9070

FAX: (951) 600-9177


(951) 600-9070

951.600.907025115 Madison AveMurrieta, CA 92562Fax: 951.600.9177

MurrietaPhone: 951.600.9070Fax: 951.600.9177

25115 Madison AveMurrieta, CA 92562951.600.9070





Murrieta25115 Madison AveMurrieta, CA 92562

951.600.9070Fax: 951.600.9177

Murrieta25115 Madison AveMurrieta, CA 92562Mon-Fri: 8 am - 7 pmPh: 951.600.9070Fx: 951.600.9177

Murrieta25115 Madison AveMurrieta, CA 92562Lun-Vier: 8 am - 7 pmPh: 951.600.9070Fx: 951.600.9177


Mon-Fri: 8 am - 7 pm951.600.9070

Fax: 951.600.9177


Lun-Vier: 8 am - 7 pm951.600.9070

Fax: 951.600.9177


951.600.9070

Mon-Fri: 8 am - 7 pm


951.600.9070

Lun-Vier: 8 am - 7 pm

Murrieta25115 Madison AveMurrieta, CA 92562P 951.600.9070

Murrieta25115 Madison AveMurrieta, CA 92562951.600.9070


P 951.600.9070F 951.600.9177


Murrieta951.600.907025115 Madison AveMurrieta, CA 92562



CA (spell this out )25115 Madison AveMurrieta, CA 92562(p) 951.600.9070

� Murrieta - 25115 Madison Ave, Murrieta, CA 92562 - 951.600.9070

Murrieta25115 Madison AveMurrieta, CA 92562Mon-Fri: 8 am - 7 pmPh: 951.600.9070Fx: 951.600.9177

3. Murrieta25115 Madison AveMurrieta, CA 92562Lun-Vier: 8 am - 7 pmPh: 951.600.9070Fx: 951.600.9177

3.

*Opening Jan. 2013

*Closing Jan. 2013Transition Date: 4/15/19

Transition Date: 4/15/19

RegularLetterhead







Surgery Postcard

Referral Postcard

EmpostEnglish

EmpostSpanish

UCF1-4 Locations




Tricare Bro (CON_PTTRI) CAS Bro (CONCAS-Bro)




Immigration Flyer

Rx PadRight Aligned


ENVRegular (Black)

CMCXRay Card

BlackLabel

ENV (Monarch)AMS

XRay CardENV

Prints on Back Flap

ENVPrints on Back Flap

2 Color Label

ENV (Monarch)Black

Rx PadCentered

TX IL Auth Format




ER TABLET

Concentra

3910 Vista Way, Ste 106Oceanside, CA 92056760.941.2000

3910 Vista Way, Ste 106

Oceanside, CA 92056

3910 Vista Way, Ste 106

Oceanside, CA 92056

3910 Vista Way, Ste 106Oceanside, CA 92056

760.941.2000760.941.4900


760.941.2000Fax: 760.941.4900


760.941.2000Fax: 760.941.4900







CONCENTRA MEDICAL CENTER3910 Vista Way, Ste 106, Oceanside, CA 92056

AMS3910 Vista Way, Ste 106, Oceanside, CA 92056

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056760.941.2000Fax: 760.941.4900

OCEANSIDE

3910 VISTA WAY, STE 106

OCEANSIDE, CA 92056

(760) 941-2000

FAX: (760) 941-4900


(760) 941-2000

760.941.20003910 Vista Way, Ste 106

Oceanside, CA 92056Fax: 760.941.4900

OceansidePhone: 760.941.2000Fax: 760.941.4900

3910 Vista Way, Ste 106Oceanside, CA 92056760.941.2000





Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056

760.941.2000Fax: 760.941.4900

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056Mon-Fri: 7 am - 7 pmSat: 8 am - 2 pmPh: 760.941.2000Fx: 760.941.4900

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056Lun-Vier: 7 am - 7 pmSáb: 8 am - 2 pmPh: 760.941.2000Fx: 760.941.4900

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056Mon-Fri: 7 am - 7 pm

Sat: 8 am - 2 pm760.941.2000

Fax: 760.941.4900

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056Lun-Vier: 7 am - 7 pm

Sáb: 8 am - 2 pm760.941.2000

Fax: 760.941.4900

Oceanside3910 Vista Way, Ste 106

Oceanside, CA 92056760.941.2000

Mon-Fri: 7 am - 7 pmSat: 8 am - 2 pm


Oceanside, CA 92056760.941.2000

Lun-Vier: 7 am - 7 pmSáb: 8 am - 2 pm

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056P 760.941.2000

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056760.941.2000


Oceanside, CA 92056P 760.941.2000F 760.941.4900


Oceanside760.941.20003910 Vista Way, Ste 106Oceanside, CA 92056



CA (spell this out )3910 Vista Way, Ste 106Oceanside, CA 92056(p) 760.941.2000

� Oceanside - 3910 Vista Way, Ste 106, Oceanside, CA 92056 - 760.941.2000

Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056Mon-Fri: 7 am - 7 pmSat: 8 am - 2 pmPh: 760.941.2000Fx: 760.941.4900

4. Oceanside3910 Vista Way, Ste 106Oceanside, CA 92056Lun-Vier: 7 am - 7 pmSáb: 8 am - 2 pmPh: 760.941.2000Fx: 760.941.4900

4.

RegularLetterhead







Surgery Postcard

Referral Postcard

EmpostEnglish

EmpostSpanish

UCF1-4 Locations








Immigration Flyer

Rx PadRight Aligned


ENVRegular (Black)

CMCXRay Card

BlackLabel

ENV (Monarch)AMS

XRay CardENV

Prints on Back Flap


2 Color Label

ENV (Monarch)Black

Rx PadCentered

TX IL Auth Format




ER TABLET

Concentra

5810 El Camino Real, Ste ACarlsbad, CA 92008760.929.8269

5810 El Camino Real, Ste A

Carlsbad, CA 92008

5810 El Camino Real, Ste A

Carlsbad, CA 92008

5810 El Camino Real, Ste ACarlsbad, CA 92008

760.929.8269760.929.8556


760.929.8269Fax: 760.929.8556


760.929.8269Fax: 760.929.8556







CONCENTRA MEDICAL CENTER5810 El Camino Real, Ste A, Carlsbad, CA 92008

AMS5810 El Camino Real, Ste A, Carlsbad, CA 92008

Carlsbad5810 El Camino Real, Ste ACarlsbad, CA 92008760.929.8269Fax: 760.929.8556

CARLSBAD

5810 EL CAMINO REAL, STE A

CARLSBAD, CA 92008

(760) 929-8269

FAX: (760) 929-8556


(760) 929-8269

760.929.82695810 El Camino Real, Ste A

Carlsbad, CA 92008Fax: 760.929.8556

CarlsbadPhone: 760.929.8269Fax: 760.929.8556

5810 El Camino Real, Ste ACarlsbad, CA 92008760.929.8269





Carlsbad5810 El Camino Real, Ste A

Carlsbad, CA 92008760.929.8269

Fax: 760.929.8556

Carlsbad5810 El Camino Real, Ste ACarlsbad, CA 92008Mon-Fri: 7 am - 6 pmPh: 760.929.8269Fx: 760.929.8556

Carlsbad5810 El Camino Real, Ste ACarlsbad, CA 92008Lun-Vier: 7 am - 6 pmPh: 760.929.8269Fx: 760.929.8556


Carlsbad, CA 92008Mon-Fri: 7 am - 6 pm

760.929.8269Fax: 760.929.8556


Carlsbad, CA 92008Lun-Vier: 7 am - 6 pm

760.929.8269Fax: 760.929.8556


Carlsbad, CA 92008760.929.8269



Carlsbad, CA 92008760.929.8269


Carlsbad5810 El Camino Real, Ste ACarlsbad, CA 92008P 760.929.8269

Carlsbad5810 El Camino Real, Ste ACarlsbad, CA 92008760.929.8269


Carlsbad, CA 92008P 760.929.8269F 760.929.8556


Carlsbad760.929.82695810 El Camino Real, Ste ACarlsbad, CA 92008



CA (spell this out )5810 El Camino Real, Ste ACarlsbad, CA 92008(p) 760.929.8269

� Carlsbad - 5810 El Camino Real, Ste A, Carlsbad, CA 92008 - 760.929.8269

Carlsbad5810 El Camino Real, Ste ACarlsbad, CA 92008Mon-Fri: 7 am - 6 pmPh: 760.929.8269Fx: 760.929.8556

1. Carlsbad5810 El Camino Real, Ste ACarlsbad, CA 92008Lun-Vier: 7 am - 6 pmPh: 760.929.8269Fx: 760.929.8556

1.

*Opening Jan. 2013

*Closing Jan. 2013

Transition Date: 4/15/19

RegularLetterhead







Surgery Postcard

Referral Postcard

EmpostEnglish

EmpostSpanish

UCF1-4 Locations








Immigration Flyer

Rx PadRight Aligned


ENVRegular (Black)

CMCXRay Card

BlackLabel

ENV (Monarch)AMS

XRay CardENV

Prints on Back Flap


2 Color Label

ENV (Monarch)Black

Rx PadCentered

TX IL Auth Format




ER TABLET

Concentra

860 W Valley Pkwy, Ste 150Escondido, CA 92025760.740.0707

860 W Valley Pkwy, Ste 150

Escondido, CA 92025

860 W Valley Pkwy, Ste 150

Escondido, CA 92025

860 W Valley Pkwy, Ste 150Escondido, CA 92025

760.740.0707760.740.0730


760.740.0707Fax: 760.740.0730


760.740.0707Fax: 760.740.0730







CONCENTRA MEDICAL CENTER860 W Valley Pkwy, Ste 150, Escondido, CA 92025

AMS860 W Valley Pkwy, Ste 150, Escondido, CA 92025

Escondido860 W Valley Pkwy, Ste 150Escondido, CA 92025760.740.0707Fax: 760.740.0730

ESCONDIDO

860 W VALLEY PKWY, STE 150

ESCONDIDO, CA 92025

(760) 740-0707

FAX: (760) 740-0730


(760) 740-0707

760.740.0707860 W Valley Pkwy, Ste 150

Escondido, CA 92025Fax: 760.740.0730

EscondidoPhone: 760.740.0707Fax: 760.740.0730

860 W Valley Pkwy, Ste 150Escondido, CA 92025760.740.0707





Escondido860 W Valley Pkwy, Ste 150

Escondido, CA 92025760.740.0707

Fax: 760.740.0730

Escondido860 W Valley Pkwy, Ste 150Escondido, CA 92025Mon-Fri: 8 am - 5 pmPh: 760.740.0707Fx: 760.740.0730

Escondido860 W Valley Pkwy, Ste 150Escondido, CA 92025Lun-Vier: 8 am - 5 pmPh: 760.740.0707Fx: 760.740.0730


Escondido, CA 92025Mon-Fri: 8 am - 5 pm

760.740.0707Fax: 760.740.0730


Escondido, CA 92025Lun-Vier: 8 am - 5 pm

760.740.0707Fax: 760.740.0730


Escondido, CA 92025760.740.0707



Escondido, CA 92025760.740.0707


Escondido860 W Valley Pkwy, Ste 150Escondido, CA 92025P 760.740.0707

Escondido860 W Valley Pkwy, Ste 150Escondido, CA 92025760.740.0707


Escondido, CA 92025P 760.740.0707F 760.740.0730


Escondido760.740.0707860 W Valley Pkwy, Ste 150Escondido, CA 92025



CA (spell this out )860 W Valley Pkwy, Ste 150Escondido, CA 92025(p) 760.740.0707

� Escondido - 860 W Valley Pkwy, Ste 150, Escondido, CA 92025 - 760.740.0707

Escondido860 W Valley Pkwy, Ste 150Escondido, CA 92025Mon-Fri: 8 am - 5 pmPh: 760.740.0707Fx: 760.740.0730

2. Escondido860 W Valley Pkwy, Ste 150Escondido, CA 92025Lun-Vier: 8 am - 5 pmPh: 760.740.0707Fx: 760.740.0730

2.

RegularLetterhead







Surgery Postcard

Referral Postcard

EmpostEnglish

EmpostSpanish

UCF1-4 Locations








Immigration Flyer

Rx PadRight Aligned


ENVRegular (Black)

CMCXRay Card

BlackLabel

ENV (Monarch)AMS

XRay CardENV

Prints on Back Flap


2 Color Label

ENV (Monarch)Black

Rx PadCentered

TX IL Auth Format




ER TABLET

South County

Concentra

542 Broadway, Ste GChula Vista, CA 91910619.425.8212

542 Broadway, Ste G

Chula Vista, CA 91910

542 Broadway, Ste G

Chula Vista, CA 91910

542 Broadway, Ste GChula Vista, CA 91910

619.425.8212619.425.1604


619.425.8212Fax: 619.425.1604


619.425.8212Fax: 619.425.1604







CONCENTRA MEDICAL CENTER542 Broadway, Ste G, Chula Vista, CA 91910

AMS542 Broadway, Ste G, Chula Vista, CA 91910

Chula Vista542 Broadway, Ste GChula Vista, CA 91910619.425.8212Fax: 619.425.1604

CHULA VISTA

542 BROADWAY, STE G

CHULA VISTA, CA 91910

(619) 425-8212

FAX: (619) 425-1604


(619) 425-8212

619.425.8212542 Broadway, Ste G

Chula Vista, CA 91910Fax: 619.425.1604

Chula VistaPhone: 619.425.8212Fax: 619.425.1604

542 Broadway, Ste GChula Vista, CA 91910619.425.8212





Chula Vista542 Broadway, Ste G

Chula Vista, CA 91910619.425.8212

Fax: 619.425.1604

Chula Vista542 Broadway, Ste GChula Vista, CA 91910Mon-Fri: 8 am - 6 pmSat: 9 am - 3 pmPh: 619.425.8212Fx: 619.425.1604

Chula Vista542 Broadway, Ste GChula Vista, CA 91910Lun-Vier: 8 am - 6 pmSáb: 9 am - 3 pmPh: 619.425.8212Fx: 619.425.1604


Chula Vista, CA 91910Mon-Fri: 8 am - 6 pm

Sat: 9 am - 3 pm619.425.8212

Fax: 619.425.1604


Chula Vista, CA 91910Lun-Vier: 8 am - 6 pm

Sáb: 9 am - 3 pm619.425.8212

Fax: 619.425.1604


Chula Vista, CA 91910619.425.8212

Mon-Fri: 8 am - 6 pmSat: 9 am - 3 pm


Chula Vista, CA 91910619.425.8212

Lun-Vier: 8 am - 6 pmSáb: 9 am - 3 pm

Chula Vista542 Broadway, Ste GChula Vista, CA 91910P 619.425.8212

Chula Vista542 Broadway, Ste GChula Vista, CA 91910619.425.8212


Chula Vista, CA 91910P 619.425.8212F 619.425.1604


Chula Vista619.425.8212542 Broadway, Ste GChula Vista, CA 91910



CA (spell this out )542 Broadway, Ste GChula Vista, CA 91910(p) 619.425.8212

� Chula Vista - 542 Broadway, Ste G, Chula Vista, CA 91910 - 619.425.8212

Chula Vista542 Broadway, Ste GChula Vista, CA 91910Mon-Fri: 8 am - 6 pmSat: 9 am - 3 pmPh: 619.425.8212Fx: 619.425.1604

11. Chula Vista542 Broadway, Ste GChula Vista, CA 91910Lun-Vier: 8 am - 6 pmSáb: 9 am - 3 pmPh: 619.425.8212Fx: 619.425.1604

11.

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ER TABLET

Concentra

102 Mile of Cars WayNational City, CA 91950619.474.9211

102 Mile of Cars Way

National City, CA 91950

102 Mile of Cars Way

National City, CA 91950

102 Mile of Cars WayNational City, CA 91950

619.474.9211619.474.2000


619.474.9211Fax: 619.474.2000


619.474.9211Fax: 619.474.2000







CONCENTRA MEDICAL CENTER102 Mile of Cars Way, National City, CA 91950

AMS102 Mile of Cars Way, National City, CA 91950

National City102 Mile of Cars WayNational City, CA 91950619.474.9211Fax: 619.474.2000

NATIONAL CITY

102 MILE OF CARS WAY

NATIONAL CITY, CA 91950

(619) 474-9211

FAX: (619) 474-2000


(619) 474-9211

619.474.9211102 Mile of Cars Way

National City, CA 91950Fax: 619.474.2000

National CityPhone: 619.474.9211Fax: 619.474.2000

102 Mile of Cars WayNational City, CA 91950619.474.9211





National City102 Mile of Cars Way

National City, CA 91950619.474.9211

Fax: 619.474.2000

National City102 Mile of Cars WayNational City, CA 91950Mon-Fri: 7 am - 7 pmPh: 619.474.9211Fx: 619.474.2000

National City102 Mile of Cars WayNational City, CA 91950Lun-Vier: 7 am - 7 pmPh: 619.474.9211Fx: 619.474.2000


National City, CA 91950Mon-Fri: 7 am - 7 pm

619.474.9211Fax: 619.474.2000


National City, CA 91950Lun-Vier: 7 am - 7 pm

619.474.9211Fax: 619.474.2000







National City102 Mile of Cars WayNational City, CA 91950P 619.474.9211

National City102 Mile of Cars WayNational City, CA 91950619.474.9211


National City, CA 91950P 619.474.9211F 619.474.2000


National City619.474.9211102 Mile of Cars WayNational City, CA 91950



CA (spell this out )102 Mile of Cars WayNational City, CA 91950(p) 619.474.9211

� National City - 102 Mile of Cars Way, National City, CA 91950 - 619.474.9211

National City102 Mile of Cars WayNational City, CA 91950Mon-Fri: 7 am - 7 pmPh: 619.474.9211Fx: 619.474.2000

12. National City102 Mile of Cars WayNational City, CA 91950Lun-Vier: 7 am - 7 pmPh: 619.474.9211Fx: 619.474.2000

12.

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ER TABLET

San Diego

Concentra

10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121858.455.0200

10350 Barnes Canyon Rd, Ste 200

San Diego, CA 92121


San Diego, CA 92121

10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121

858.455.0200858.455.0044


San Diego, CA 92121858.455.0200

Fax: 858.455.0044


858.455.0200Fax: 858.455.0044







CONCENTRA MEDICAL CENTER10350 Barnes Canyon Rd, Ste 200, San Diego, CA 92121

AMS10350 Barnes Canyon Rd, Ste 200, San Diego, CA 92121

Sorrento Mesa10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121858.455.0200Fax: 858.455.0044

SORRENTO MESA

10350 BARNES CANYON RD, STE 200

SAN DIEGO, CA 92121

(858) 455-200

FAX: (858) 455-0044


(858) 455-200

858.455.020010350 Barnes Canyon Rd, Ste 200

San Diego, CA 92121Fax: 858.455.0044

Sorrento MesaPhone: 858.455.0200Fax: 858.455.0044

10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121858.455.0200





Sorrento Mesa10350 Barnes Canyon Rd, Ste 200

San Diego, CA 92121858.455.0200

Fax: 858.455.0044

Sorrento Mesa10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121Mon-Fri: 8 am - 5 pmPh: 858.455.0200Fx: 858.455.0044

Sorrento Mesa10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121Lun-Vier: 8 am - 5 pmPh: 858.455.0200Fx: 858.455.0044


San Diego, CA 92121Mon-Fri: 8 am - 5 pm

858.455.0200Fax: 858.455.0044


San Diego, CA 92121Lun-Vier: 8 am - 5 pm

858.455.0200Fax: 858.455.0044


San Diego, CA 92121858.455.0200



San Diego, CA 92121858.455.0200


Sorrento Mesa10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121P 858.455.0200

Sorrento Mesa10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121858.455.0200


San Diego, CA 92121P 858.455.0200F 858.455.0044


Sorrento Mesa858.455.020010350 Barnes Canyon Rd, Ste 200San Diego, CA 92121



CA (spell this out )10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121(p) 858.455.0200

� San Diego - 10350 Barnes Canyon Rd, Ste 200, San Diego, CA 92121 - 858.455.0200

Sorrento Mesa10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121Mon-Fri: 8 am - 5 pmPh: 858.455.0200Fx: 858.455.0044

10. Sorrento Mesa10350 Barnes Canyon Rd, Ste 200San Diego, CA 92121Lun-Vier: 8 am - 5 pmPh: 858.455.0200Fx: 858.455.0044

10.

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ER TABLET

Concentra

3930 Fourth Ave, Ste 200San Diego, CA 92103619.297.9610

3930 Fourth Ave, Ste 200

San Diego, CA 92103

3930 Fourth Ave, Ste 200

San Diego, CA 92103

3930 Fourth Ave, Ste 200San Diego, CA 92103

619.297.9610619.297.2244


619.297.9610Fax: 619.297.2244


619.297.9610Fax: 619.297.2244







CONCENTRA MEDICAL CENTER3930 Fourth Ave, Ste 200, San Diego, CA 92103

AMS3930 Fourth Ave, Ste 200, San Diego, CA 92103

Hillcrest3930 Fourth Ave, Ste 200San Diego, CA 92103619.297.9610Fax: 619.297.2244

HILLCREST

3930 FOURTH AVE, STE 200

SAN DIEGO, CA 92103

(619) 297-9610

FAX: (619) 297-2244


(619) 297-9610

619.297.96103930 Fourth Ave, Ste 200

San Diego, CA 92103Fax: 619.297.2244

HillcrestPhone: 619.297.9610Fax: 619.297.2244

3930 Fourth Ave, Ste 200San Diego, CA 92103619.297.9610





Hillcrest3930 Fourth Ave, Ste 200

San Diego, CA 92103619.297.9610

Fax: 619.297.2244

Hillcrest3930 Fourth Ave, Ste 200San Diego, CA 92103Mon-Fri: 7 am - 7 pmPh: 619.297.9610Fx: 619.297.2244

Hillcrest3930 Fourth Ave, Ste 200San Diego, CA 92103Lun-Dom: 7 am - 7 pmPh: 619.297.9610Fx: 619.297.2244


San Diego, CA 92103Mon-Fri: 7 am - 7 pm

619.297.9610Fax: 619.297.2244


San Diego, CA 92103Lun-Dom: 7 am - 7 pm

619.297.9610Fax: 619.297.2244


San Diego, CA 92103619.297.9610



San Diego, CA 92103619.297.9610

Lun-Dom: 7 am - 7 pm

Hillcrest3930 Fourth Ave, Ste 200San Diego, CA 92103P 619.297.9610

Hillcrest3930 Fourth Ave, Ste 200San Diego, CA 92103619.297.9610


San Diego, CA 92103P 619.297.9610F 619.297.2244


Hillcrest619.297.96103930 Fourth Ave, Ste 200San Diego, CA 92103



CA (spell this out )3930 Fourth Ave, Ste 200San Diego, CA 92103(p) 619.297.9610

� San Diego - 3930 Fourth Ave, Ste 200, San Diego, CA 92103 - 619.297.9610

Hillcrest3930 Fourth Ave, Ste 200San Diego, CA 92103Mon-Fri: 7 am - 7 pmPh: 619.297.9610Fx: 619.297.2244

6. Hillcrest3930 Fourth Ave, Ste 200San Diego, CA 92103Lun-Dom: 7 am - 7 pmPh: 619.297.9610Fx: 619.297.2244

6.

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Concentra

5575 Ruffi n Rd, Ste 100San Diego, CA 92123858.277.2744

5575 Ruffin Rd, Ste 100

San Diego, CA 92123

5575 Ruffin Rd, Ste 100

San Diego, CA 92123

5575 Ruffi n Rd, Ste 100San Diego, CA 92123

858.277.2744858.277.3085

5575 Ruffin Rd, Ste 100San Diego, CA 92123

858.277.2744Fax: 858.277.3085


858.277.2744Fax: 858.277.3085







CONCENTRA MEDICAL CENTER5575 Ruffin Rd, Ste 100, San Diego, CA 92123

AMS5575 Ruffin Rd, Ste 100, San Diego, CA 92123

Kearny Mesa5575 Ruffi n Rd, Ste 100San Diego, CA 92123858.277.2744Fax: 858.277.3085

KEARNY MESA

5575 RUFFIN RD, STE 100

SAN DIEGO, CA 92123

(858) 277-2744

FAX: (858) 277-3085


(858) 277-2744

858.277.27445575 Ruffi n Rd, Ste 100

San Diego, CA 92123Fax: 858.277.3085

Kearny MesaPhone: 858.277.2744Fax: 858.277.3085

5575 Ruffi n Rd, Ste 100San Diego, CA 92123858.277.2744





Kearny Mesa5575 Ruffin Rd, Ste 100San Diego, CA 92123

858.277.2744Fax: 858.277.3085

Kearny Mesa5575 Ruff in Rd, Ste 100San Diego, CA 92123Open 24/7Ph: 858.277.2744Fx: 858.277.3085

Kearny Mesa5575 Ruff in Rd, Ste 100San Diego, CA 92123Abierto 24/7Ph: 858.277.2744Fx: 858.277.3085


Open 24/7858.277.2744

Fax: 858.277.3085


Abierto 24/7858.277.2744

Fax: 858.277.3085

Kearny Mesa5575 Ruffi n Rd, Ste 100

San Diego, CA 92123858.277.2744

Open 24/7


San Diego, CA 92123858.277.2744

Abierto 24/7

Kearny Mesa5575 Ruffi n Rd, Ste 100San Diego, CA 92123P 858.277.2744

Kearny Mesa5575 Ruffi n Rd, Ste 100San Diego, CA 92123858.277.2744


San Diego, CA 92123P 858.277.2744F 858.277.3085


Kearny Mesa858.277.27445575 Ruff in Rd, Ste 100San Diego, CA 92123



CA (spell this out )5575 Ruffi n Rd, Ste 100San Diego, CA 92123(p) 858.277.2744

� San Diego - 5575 Ruffin Rd, Ste 100, San Diego, CA 92123 - 858.277.2744

Kearny Mesa5575 Ruff in Rd, Ste 100San Diego, CA 92123Open 24/7Ph: 858.277.2744Fx: 858.277.3085

7. Kearny Mesa5575 Ruff in Rd, Ste 100San Diego, CA 92123Abierto 24/7Ph: 858.277.2744Fx: 858.277.3085

7.

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ER TABLET

Concentra

7590 Miramar Rd, Ste CSan Diego, CA 92126858.549.4255

7590 Miramar Rd, Ste C

San Diego, CA 92126

7590 Miramar Rd, Ste C

San Diego, CA 92126

7590 Miramar Rd, Ste CSan Diego, CA 92126

858.549.4255858.549.4552


858.549.4255Fax: 858.549.4552


858.549.4255Fax: 858.549.4552







CONCENTRA MEDICAL CENTER7590 Miramar Rd, Ste C, San Diego, CA 92126

AMS7590 Miramar Rd, Ste C, San Diego, CA 92126

Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126858.549.4255Fax: 858.549.4552

MIRAMAR

7590 MIRAMAR RD, STE C

SAN DIEGO, CA 92126

(858) 549-4255

FAX: (858) 549-4552


(858) 549-4255

858.549.42557590 Miramar Rd, Ste CSan Diego, CA 92126Fax: 858.549.4552

MiramarPhone: 858.549.4255Fax: 858.549.4552

7590 Miramar Rd, Ste CSan Diego, CA 92126858.549.4255





Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126

858.549.4255Fax: 858.549.4552

Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126Mon-Fri: 8 am - 5 pmPh: 858.549.4255Fx: 858.549.4552

Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126Lun-Vier: 8 am - 5 pmPh: 858.549.4255Fx: 858.549.4552

Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126Mon-Fri: 8 am - 5 pm

858.549.4255Fax: 858.549.4552

Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126Lun-Vier: 8 am - 5 pm

858.549.4255Fax: 858.549.4552

Miramar7590 Miramar Rd, Ste C

San Diego, CA 92126858.549.4255



San Diego, CA 92126858.549.4255


Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126P 858.549.4255

Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126858.549.4255


San Diego, CA 92126P 858.549.4255F 858.549.4552


Miramar858.549.42557590 Miramar Rd, Ste CSan Diego, CA 92126



CA (spell this out )7590 Miramar Rd, Ste CSan Diego, CA 92126(p) 858.549.4255

� San Diego - 7590 Miramar Rd, Ste C, San Diego, CA 92126 - 858.549.4255

Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126Mon-Fri: 8 am - 5 pmPh: 858.549.4255Fx: 858.549.4552

8. Miramar7590 Miramar Rd, Ste CSan Diego, CA 92126Lun-Vier: 8 am - 5 pmPh: 858.549.4255Fx: 858.549.4552

8.

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ER TABLET

Concentra

5333 Mission Center Rd.

Suite 100

San Diego, CA 92108

5333 Mission Center Rd.

Suite 100

San Diego, CA 92108

5333 Mission Center Rd.Suite 100

San Diego, CA 92108

619.295.3355619.542.1317


San Diego, CA 92108619.295.3355

Fax: 619.542.1317


San Diego, CA 92108619.295.3355

Fax: 619.542.1317

5333 Mission Center Rd.Suite 100San Diego, CA 92108

5333 Mission Center Rd.Suite 100San Diego, CA 92108


San Diego, CA 92108


San Diego, CA 92108

5333 Mission Center Rd., Ste. 100San Diego, CA 92108

5333 Mission Center Rd., Ste. 100San Diego, CA 92108

Concentra Mission Valley Center5333 Mission Center Rd., Ste. 100San Diego, CA 92108619.295.3355Fax: 619.542.1317


San Diego, CA 92108(Phone2Area) Phone2

619.295.33555333 Mission Center Rd.

Suite 100San Diego, CA 92108Fax: 619.542.1317

Concentra Mission Valley CenterPhone: 619.295.3355Fax: 619.542.1317

5333 Mission Center Rd.Suite 100San Diego, CA 92108619.295.3355

Concentra Mission Valley Center5333 Mission Center Rd.Suite 100San Diego, CA 92108619.295.3355Fax: 619.542.1317




Concentra Mission Valley Center5333 Mission Center Rd.

Suite 100San Diego, CA 92108

619.295.3355Fax: 619.542.1317


Suite 100San Diego, CA 92108Mon - Fri: 8 am - 6 pm

619.295.3355Fax: 619.542.1317


Suite 100San Diego, CA 92108Lun - Viér: 8 am - 6 pm

619.295.3355Fax: 619.542.1317



619.295.3355

Mon - Fri: 8 am - 6 pm



619.295.3355

Lun - Viér: 8 am - 6 pm

Concentra Mission Valley Center5333 Mission Center Rd.Suite 100San Diego, CA 92108P 619.295.3355

Concentra Mission Valley Center5333 Mission Center Rd.Suite 100San Diego, CA 92108619.295.3355



P 619.295.3355F 619.542.1317




*Opening Jan. 2013

*Closing Jan. 2013

CA (spell this out )5333 Mission Center Rd.Suite 100San Diego, CA 92108(p) 619.295.3355

Mission Valley5333 Mission Center Rd, Ste 100San Diego, CA 92108Mon-Fri: 8 am - 6 pmPh: 619.295.3355Fx: 619.542.1317

9. Mission Valley5333 Mission Center Rd, Ste 100San Diego, CA 92108Lun-Viér: 8 am - 6 pmPh: 619.295.3355Fx: 619.542.1317

9.

5333 Mission Center Rd.Suite 100San Diego, CA 92108619.295.3355

Mission Valley5333 Mission Center Rd, Ste 100San Diego, CA 92108Mon-Fri: 8 am - 6 pmPh: 619.295.3355Fx: 619.542.1317

Mission Valley5333 Mission Center Rd, Ste 100San Diego, CA 92108Lun-Viér: 8 am - 6 pmPh: 619.295.3355Fx: 619.542.1317

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ER TABLET

East County

Concentra

8090 Parkway DrLa Mesa, CA 91942619.697.3093

8090 Parkway Dr

La Mesa, CA 91942

8090 Parkway Dr

La Mesa, CA 91942

8090 Parkway DrLa Mesa, CA 91942

619.697.3093619.697.3135


619.697.3093Fax: 619.697.3135


619.697.3093Fax: 619.697.3135







CONCENTRA MEDICAL CENTER8090 Parkway Dr, La Mesa, CA 91942

AMS8090 Parkway Dr, La Mesa, CA 91942

La Mesa8090 Parkway DrLa Mesa, CA 91942619.697.3093Fax: 619.697.3135

LA MESA

8090 PARKWAY DR

LA MESA, CA 91942

(619) 697-3093

FAX: (619) 697-3135


(619) 697-3093

619.697.30938090 Parkway Dr

La Mesa, CA 91942Fax: 619.697.3135

La MesaPhone: 619.697.3093Fax: 619.697.3135

8090 Parkway DrLa Mesa, CA 91942619.697.3093





La Mesa8090 Parkway Dr

La Mesa, CA 91942619.697.3093

Fax: 619.697.3135

La Mesa8090 Parkway DrLa Mesa, CA 91942Mon-Fri: 8 am - 5 pmPh: 619.697.3093Fx: 619.697.3135

La Mesa8090 Parkway DrLa Mesa, CA 91942Lun-Vier: 8 am - 5 pmPh: 619.697.3093Fx: 619.697.3135


La Mesa, CA 91942Mon-Fri: 8 am - 5 pm

619.697.3093Fax: 619.697.3135


La Mesa, CA 91942Lun-Vier: 8 am - 5 pm

619.697.3093Fax: 619.697.3135


La Mesa, CA 91942619.697.3093



La Mesa, CA 91942619.697.3093


La Mesa8090 Parkway DrLa Mesa, CA 91942P 619.697.3093

La Mesa8090 Parkway DrLa Mesa, CA 91942619.697.3093


La Mesa, CA 91942P 619.697.3093F 619.697.3135


La Mesa619.697.30938090 Parkway DrLa Mesa, CA 91942



CA (spell this out )8090 Parkway DrLa Mesa, CA 91942(p) 619.697.3093

� La Mesa - 8090 Parkway Dr, La Mesa, CA 91942 - 619.697.3093

La Mesa8090 Parkway DrLa Mesa, CA 91942Mon-Fri: 8 am - 5 pmPh: 619.697.3093Fx: 619.697.3135

13. La Mesa8090 Parkway DrLa Mesa, CA 91942Lun-Vier: 8 am - 5 pmPh: 619.697.3093Fx: 619.697.3135

13.

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Concentra

9745 Prospect Ave, Ste 100Santee, CA 92071619.448.4841

9745 Prospect Ave, Ste 100

Santee, CA 92071

9745 Prospect Ave, Ste 100

Santee, CA 92071

9745 Prospect Ave, Ste 100Santee, CA 92071

619.448.4841619.448.8700


619.448.4841Fax: 619.448.8700


619.448.4841Fax: 619.448.8700







CONCENTRA MEDICAL CENTER9745 Prospect Ave, Ste 100, Santee, CA 92071

AMS9745 Prospect Ave, Ste 100, Santee, CA 92071

Santee9745 Prospect Ave, Ste 100Santee, CA 92071619.448.4841Fax: 619.448.8700

SANTEE

9745 PROSPECT AVE, STE 100

SANTEE, CA 92071

(619) 448-4841

FAX: (619) 448-8700


(619) 448-4841

619.448.48419745 Prospect Ave, Ste 100

Santee, CA 92071Fax: 619.448.8700

SanteePhone: 619.448.4841Fax: 619.448.8700

9745 Prospect Ave, Ste 100Santee, CA 92071619.448.4841





Santee9745 Prospect Ave, Ste 100

Santee, CA 92071619.448.4841

Fax: 619.448.8700

Santee9745 Prospect Ave, Ste 100Santee, CA 92071Mon-Fri: 7 am - 5 pmPh: 619.448.4841Fx: 619.448.8700

Santee9745 Prospect Ave, Ste 100Santee, CA 92071Lun-Vier: 7 am - 5 pmPh: 619.448.4841Fx: 619.448.8700


Santee, CA 92071Mon-Fri: 7 am - 5 pm

619.448.4841Fax: 619.448.8700


Santee, CA 92071Lun-Vier: 7 am - 5 pm

619.448.4841Fax: 619.448.8700


Santee, CA 92071619.448.4841



Santee, CA 92071619.448.4841


Santee9745 Prospect Ave, Ste 100Santee, CA 92071P 619.448.4841

Santee9745 Prospect Ave, Ste 100Santee, CA 92071619.448.4841


Santee, CA 92071P 619.448.4841F 619.448.8700


Santee619.448.48419745 Prospect Ave, Ste 100Santee, CA 92071



CA (spell this out )9745 Prospect Ave, Ste 100Santee, CA 92071(p) 619.448.4841

� Santee - 9745 Prospect Ave, Ste 100, Santee, CA 92071 - 619.448.4841

Santee9745 Prospect Ave, Ste 100Santee, CA 92071Mon-Fri: 7 am - 5 pmPh: 619.448.4841Fx: 619.448.8700

14. Santee9745 Prospect Ave, Ste 100Santee, CA 92071Lun-Vier: 7 am - 5 pmPh: 619.448.4841Fx: 619.448.8700

14.

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ER TABLET

audrey.hotaling

Highlight

audrey.hotaling

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Covered Employee Notification of Rights MaterialsRegarding

San Diego County SchooSan Diego County Schoo

MPN ID #1401

This pamphlet contains important information about your medical care in case of a work-related injury or illness

You Are Important To UsKeeping you well and fully employed is important to us. It is your employer’s goal to provide you employment in asafe working environment. However, should you become injured or ill, as a result of your job, we want to ensureyou receive prompt quality medical treatment. Our goal is to assist you in making a full recovery and returning toyour job as soon as possible. In compliance with California law, we provide workers’ compensation benefits, whichinclude the payment of all appropriate medical treatment for work-related injuries or illnesses. If you have anyquestions regarding the MPN, please contact Felicia Amenta by phone at (800) 560-5060 , oremail [email protected] . If you need an explanation about your medical treatment for your work-relatedinjury or illness you can contact your claims examiner if one has been assigned to your case.

San Diego County Schools JPA “MPN”

San Diego County Schoo provides access to medical treatment in the event you sustain a work-related injury orillness through San Diego County Schoo . San Diego County Schoo accesses medical treatment through selectedAnthem Blue Cross Prudent Buyer PPO (“Blue Cross of California”) providers and the Kaiser-On-the-Job ProviderNetwork. Anthem Blue Cross contracts with doctors, hospitals and other providers to respond to the specialrequirements of on-the-job injuries or illnesses. Access to CareIf you should experience a work-related injury or illness, you should:Notify your employer:

Immediately notify your supervisor or employer representative so you can secure medical care. Employers are required to authorize medical treatment within one working day of your filing of acompleted claim form (DWC-1). To ensure your rights to benefits, report every injury and request aclaim form.

Initial or Urgent Care: If medical treatment is needed, your employer will direct you to an MPN provider upon initial report of

injury. An appointment for initial medical care should be immediate but in no event longer than 3business days of a covered employee’s notice to your employer or MPN Medical Access Assistant thattreatment is needed.

For Emergency Care: In the case of emergency* go to the nearest healthcare provider. Once your condition is stable,

contact your employer, the claims administrator Athens Administrators at (, or Medical AccessAssistant for assistance in locating a MPN provider for continued care.

*Emergency care is defined as a need for those health care services provided to evaluate and treat medicalconditions of a recent onset and severity that would lead a lay person, possessing an average knowledge ofmedicine, to believe that urgent care is required.

Subsequent Care:

All medical non-emergencies, which require ongoing treatment, in-depth medical testing or arehabilitation program, must be authorized by your claims examiner and based upon medically evidencedbased treatment guidelines (California Labor Code §5307.27, and as set forth in title 8, California Code ofRegulations, section 9792.20 et seq.). Access to subsequent care, including specialist services, shall beavailable within no more than twenty (20) business days of a covered employee’s reasonable requests for anappointment through an MPN Medical Access Assistant. If an MPN Medical Access Assistant is unable withinten business days to schedule an initial medical appointment that will occur within twenty (20) business days ofan employee’s request, then San Diego County Schoo shall permit the employee to obtain necessarytreatment with an appropriate specialist outside of the MPN. The MPN physician, who is the primary carephysician, will continue to direct all of the covered injured employee’s medical treatment needs.

If a covered employee is not able to obtain from an MPN physician reasonable and necessarymedical treatment within the applicable access standards noted above, the covered employee will be permittedto obtain necessary treatment for that injury from an appropriate specialist outside the MPN within a reasonablegeographic area. When the MPN is able to provide the necessary treatment through an MPN physician, a

covered employee treating outside the MPN may be required to treat with an MPN physician when a transfer isappropriate.

If ancillary services are not available within a reasonable time or a reasonable geographic area to acovered employee, then the employee may obtain necessary ancillary services outside of the MPN within areasonable geographic area.

If you are temporarily working, relocate or move outside of the MPNs geographic servicearea and are injured:

The following is San Diego County Schoo ’s written policy for arranging or approving non-emergency medicalcare for: (1) a covered employee authorized by the employer to temporarily work or travel for work outside ofthe MPN geographic service area when the need for medical care arises; (2) a former employee whoseemployer has ongoing workers’ compensation obligations and who permanently resides outside the MPNgeographic service area; and (3) an injured employee who decides to temporarily reside outside the MPNgeographic service area during recovery.

When an employee has a work-related non-emergent injury or illness outside of the service area, theemployee should notify the employer and seek treatment at the closest occupational health or primary careclinic to the patient.

In the event of an emergency or if urgent care is needed, the employee should seek medical attention fromthe nearest hospital or urgent care center. If feasible, the employee or a personal representative shouldreport his/her injury/illness within 24 hours of receiving treatment.

Once the injured/ill employee returns to the service area, medical care will be transferred to a providerwithin the MPN.

Employees that are temporarily working, relocate or move outside of the MPNs geographic service area willhave a choice of at least three physicians outside the MPN geographic service area who either have beenreferred by the employee’s primary treating physician within the MPN or have been selected by the MPNApplicant. In addition to the physicians within the MPN, the employee may change physicians among thereferred physicians and may obtain a second and third opinion from the referred physicians. Referredphysicians will be located within the access standards described in this notice e.g. 15 miles or 30 minutesfor primary care and 30 miles or 60 minutes for specialty care.

The MPN does not prevent a covered employee outside the MPN geographic service area from choosing aprovider for non-emergency medical care.

Upon your return to the MPN geographic service area, should you require ongoing medical care,immediately contact your claims examiner or your employer for referral to a MPN provider for continuedcare.

How to Choose a Physician within the MPN

The MPN has providers for San Diego County, Imperial County, Orange County and Riverside County. The MPNmust give you a regional list of providers that includes at least 3 physicians in each specialty commonly used totreat work related injuries or illnesses in your industry. The MPN must provide access to primary care physicianswithin 15 miles or 30 minutes, and specialists within 30 miles or 60 minutes. To locate a participating provider or obtain a regional listing:Provider Directories:

On-line Directories – if you have internet access, you can access the roster of all treating physicians in theMPN by going to the website: Https://www.viiad.com/ant. A copy of the complete provider listing is alsoavailable in writing or electronic copy upon request. For more information about the MPN go to http://www.sdcoe.net/busi. Secondary treating physicians and specialists that can only be seen with anapproved referral are clearly designated “by referral only” in the online provider finder and roster of alltreating physicians.

If you do not have internet access, you may request assistance locating an MPN provider or obtaining anappointment by contacting the Medical Access Assistant at (844) 752-1141 , email at SDJPAMAA@anthemwc. , and fax (855) 279-2512 .

Promptly contact your claims examiner to notify us of any appointment you schedule with an MPN provider.

Choosing a Physician (for all initial and subsequent care):

Your employer will direct you to an MPN provider upon initial report of injury. You have the right to betreated by a physician of your choice within the MPN after your initial visit. The providers you choose should be appropriate to treat your injury If you wish to change your MPN physician after your initial visit, you may do so by:

Accessing the on-line provider directories (see above) Call the Medical Access Assistant or Claims Professional

If you have trouble getting an appointment with a provider within the MPN contact the Medical AccessAssistant as soon as you are able and they can assist you. If you select a new physician, immediately contact your claims examiner and provide him or her with thename, address and phone number of the physician you have selected. You should also provide the dateand time of your initial evaluation.If it is medically necessary for your treatment to be referred to a specialist, your MPN physician can makethe appropriate referral within the network or you may select a specialist of your choice within the MPNIf a chiropractor is selected as a treating physician, the chiropractor may act as a treating physician onlyuntil the 24-visit cap is met unless otherwise authorized by the employer or insurer, after which the coveredemployee must select another treating physician in the MPN who is not a chiropractor, and if the employeefails to do so, then the insurer or employer may assign another treating physician who is not a chiropractor. If a type of specialist is needed, or recommended by your MPN physician, but is not available to you withinthe network, you will be allowed to treat with a specialist outside of the network. Your claims examiner canassist you to identify appropriate specialists if requested. Once you have identified the appropriatespecialist outside of the network, schedule an appointment and notify your primary care physician andclaims examiner of the appointment date and time. Your MPN physician, who is your primary carephysician, will continue to direct all of your medical treatment needs.

If the MPN cannot provide access to a primary treating physician within 15 miles or 30 minutes of yourworkplace or residence, the MPN may allow you to seek treatment outside the MPN. Please contact yourclaims examiner for assistance.

Medical Access Assistant(s)MPN Medical Access Assistants are available, at a minimum, from Monday through Saturday (excluding Sundaysand holidays) from 7 am to 8 pm, Pacific Time, to provide covered employee assistance with access to medicalcare under the MPN. The assistance includes but is not limited to contacting provider offices during regularbusiness hours to find available MPN physicians of your choice, and scheduling and confirming physician medicalappointments. Assistance is available in English and Spanish. At least one MPN medical access assistant is available to respond at all required times, with the ability for callers toleave a voice message. Medical access assistants will respond to calls, faxes or messages by the next day,excluding Sundays and holidays. MAAs work in coordination with the MPN Contact and the claims adjuster(s) toensure timely and appropriate medical treatment is available to you. You may contact the Medical Access Assistantat (844) 752-1141 , email at [email protected], and fax (855) 279-2512 . Second and Third Opinions

Second Opinion:

If you disagree with the either the diagnosis or the treatment prescribed by your MPN physician, you mayobtain a second opinion within the MPN. During this process you are required to continue your treatmentwith an MPN physician of your choice. In order to obtain a second opinion you and the MPN share responsibilities:

Inform your claims examiner of your dispute regarding your treating physician’s opinion eitherorally or in writing.

You are to select a physician or specialist from a regional list of available MPN providers, whichwill be provided to you by your claims examiner upon notification of your request for a secondopinion.

You are to make an appointment within 60 days. You are to inform your claims examiner of the appointment date and time. You shall be deemed to have waived your right to a second opinion if you do not make an

appointment within 60 days from receipt of the list. You have the right to request a copy of the medical records sent to the second opinion

physicians. If the second opinion doctor feels that your injury is outside of the type of injury he or she

normally treats, the doctor's office will notify you and your employer or insurer. You will getanother list of MPN doctors or specialists so you can make another selection.

Third Opinion:

If you disagree with either the diagnosis or the treatment prescribed by the second opinion physician, youmay obtain a third opinion within the MPN. During this process you are required to continue your treatmentwith a MPN physician of your choice. In order to obtain a third opinion you and the MPN shareresponsibilities:

Inform your claims examiner of your dispute regarding your treating physician’s opinion eitherorally or in writing.

You are to select a physician or specialist from the list of available MPN providers previouslyprovided or you may request a new regional area list.

You are to make an appointment within 60 days. You are to inform your claims examiner of the appointment date and time. You shall be deemed to have waived your right to a third opinion if you do not make an

appointment within 60 days from receipt of the list. You have the right to request a copy of the medical records sent to the third opinion physician. If the third opinion doctor feels that your injury is outside of the type of injury he or she normally

treats, the doctor's office will notify you and your employer or insurer. You will get another list ofMPN doctors or specialists so you can make another selection.

If the MPN does not contain a physician who can provide the treatment recommended by the Second orThird Opinion physician, the employee may choose a physician outside the MPN within a reasonablegeographic area. The covered employee may obtain the recommended treatment by changing physiciansto the second opinion physician, third opinion physician, or other MPN physician

At the time of selection of the physician for a third opinion, the MPN Contact will notify you about the MPNIndependent Medical Review process and provide you with an application for the Independent MedicalReview process (see below). If you disagree with the third-opinion doctor, you may ask for an MPN Independent Medical Review (IMR). Your employer or MPN Contact will give you information on requesting an Independent Medical Reviewand a form at the time you select a third-opinion physician. If either the second or third-opinion doctor or Independent Medical Reviewer agrees with your need for atreatment or test, you may be allowed to receive that medical service from a provider within the MPN or ifthe MPN does not contain a physician who can provide the recommended treatment, you may choose aphysician outside the MPN within a reasonable geographic area.

Continuity of Care PolicyYour employer or insurer has a written “Continuity of Care” policy that will determine whether you can temporarilycontinue treatment for an existing work injury with your doctor if your doctor is no longer participating in the MPN. If your employer decides that you do not qualify to continuing your care with the non-MPN provider, you and yourprimary treating physician must receive a letter of notification. If you meet certain conditions, you may qualify to continue treating with this doctor for up to a year before you mustswitch to MPN physicians. These conditions are:

(Acute) The treatment for your injury or illness will be completed in less than 90 days;(Serious or chronic) Your injury or illness is one that is serious and continues for at least 90 days withoutfull cure or worsens and requires ongoing treatment. You may be allowed to be treated by your currenttreating doctor for up to one year, until a safe transfer of care can be made.(Terminal) You have an incurable illness or irreversible condition that is likely to cause death within oneyear or less.(Pending Surgery) You already have a surgery or other procedure that has been authorized by youremployer or insurer that will occur within 180 days of the termination of contract date between the MPN andyour doctor.

You can disagree with your employer’s decision to deny you Continuity of Care with the terminated MPN provider. If you want to continue treating with the terminated doctor, ask your primary treating physician for a medical reporton whether you have one of the four conditions stated above to see if you qualify to continue treating with yourcurrent doctor temporarily. Your primary treating physician has 20 days from the date of your request to give you a copy of his/her medicalreport on your condition. If your primary treating physician does not give you the report within 20 days of yourrequest, the employer can transfer your care to another physician within the MPN. You will need to give a copy of the report to your employer if you wish to postpone the transfer of your care into theMPN. If you or your employer disagrees with your doctor’s report on your condition, you or your employer candispute it. See the complete Continuity of Care policy for more details on the dispute resolution process. For a copy of the entire Continuity of Care policy in English or Spanish, ask your MPN Contact or your claimsexaminer. Transfer of Care PolicyYour employer or insurer has a “Transfer of Care” policy which will determine if you can continue being temporarilytreated for an existing work-related injury by a physician outside of the MPN before your care is transferred into theMPN. If you have properly predesignated a primary treating physician, you cannot be transferred into the MPN. (If youhave questions about predesignation, ask your supervisor.) If your current doctor is not or does not become amember of the MPN, then you may be required to see a MPN physician. If your employer decides to transfer you into the MPN, you and your primary treating physician must receive a

letter notifying you of the transfer. If you meet certain conditions, you may qualify to continue treating with a non-MPN physician for up to a yearbefore you are transferred into the MPN. The qualifying conditions to postpone the transfer of your care into theMPN are:

(Acute) The treatment for your injury or illness will be completed in less than 90 days;(Serious or chronic) Your injury or illness is one that is serious and continues for at least 90 days withoutfull cure or worsens and requires ongoing treatment. You may be allowed to be treated by your currenttreating doctor for up to one year, until a safe transfer of care can be made.(Terminal) You have an incurable illness or irreversible condition that is likely to cause death within oneyear or less.(Pending Surgery) You already have a surgery or other procedure that has been authorized by youremployer or insurer that will occur within 180 days of the MPN effective date.

You can disagree with your employer’s decision to transfer your care into the MPN. If you don’t want to betransferred into the MPN, ask your primary treating physician for a medical report on whether you have one of thefour conditions stated above to qualify for a postponement of your transfer into the MPN. Your primary treating physician has 20 days from the date of your request to give you a copy of his/her report onyour condition. If your primary treating physician does not give you the report within 20 days of your request, theemployer can transfer your care into the MPN and you will be required to use a MPN physician. You will need to give a copy of the report to your employer if you wish to postpone the transfer of your care. If youor your employer disagrees with your doctor’s report on your condition, you or your employer can dispute it. Seethe complete transfer of care policy for more details on the dispute resolution process. For a copy of the entire transfer of care policy in English or Spanish, ask your MPN Contact or your claimsexaminer.For Questions or MPN InformationWhat if I have questions or need help:

MPN Contact: You may always contact the MPN Contact to answer questions about the use of MPNs orto submit a formal MPN complaint by mail at 6401 Linda Vista Road Sa, phone at (800) 560-5060 , by fax (858) 279-6236 , or email [email protected]. If you needan explanation about your medical treatment for your work-related injury or illness you can contact yourclaims examiner if one has been assigned to your case.

Medical Access Assistants are available Monday through Saturday (excluding Sundays andholidays) from 7 am to 8 pm, Pacific Time, by phone at (844) 752-1141 , email at SDJPAMAA@anthemwc. , fax (855) 279-2512 .

Division of Workers’ Compensation (DWC): If you have concerns, complaints or questions regardingthe MPN, the notification process or your medical treatment after a work-related injury or illness, you cancall DWC’s Information and Assistance Unit at 800-736-7401. You can also go to DWC’s website atwww.dir.ca.gov/dwc and click on “Medical provider networks” for more information about MPNs.

Independent Medical Review: If you have questions about the Independent Medical Review processcontact the Division of Workers’ Compensation Medical Unit at:

DWC Medical UnitP.O. Box 71010Oakland CA 94612(510)286-3700 or (800)794-6900

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