EMPLOYEE NOTICE
Lynchburg, VA
ALL ACCIDENTS MUST BE
SUPERVISOR IMMEDIATELY!
REPORTED
TO
YOUR
Medical expenses will be considered when this form is completed prior to
treatment and in accordance with the Workers’ Compensation laws of the
State of Virginia.
FOR WORK RELATED INJURIES, MEDICAL SERVICES MAY BE OBTAINED FROM ONE OF
THE MEDICAL FACILITIES LISTED BELOW. PLEASE CIRCLE YOUR CHOICE.
Immediate Care
HealthWorks
1905 Atherholt Road
Lynchburg, VA
434 200-6934
Physicians Treatment Center
2832 Candlers Mtn. Road
Lynchburg, VA
434 239-3949
LU Health Services
1971 University Blvd
Lynchburg, VA
434 200-6370
Hospital – One time visit and only in an emergency.
Lynchburg General Hospital
1901 Tate Springs Road
Lynchburg, VA
Should a referral to a specialist be recommended, please contact claims adjuster for
further direction.
Employee_______________________________________________Date___________________________
Primary contact: John Peterson at 592-4846
Secondary contact: Steve Foster at 592-3345
Revised: 0711