Physician Pre-Designation
Employees have the option of pre-designating their personal physician as their treating physician in the event of a work-related injury/illness. This designation must occur prior to a work-related injury/illness and your physician must agree to be pre-designated. Employees bear the responsibility of keeping their physician pre-designation current.
Note: A personal physician includes a medical group, if the medical group is composed of licensed doctors of medicine or osteopathy operating as a multi-specialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries (e.g. Kaiser Permanente). A specialist or specialty group, such as an orthopedist, cannot be pre-designated.Submit your form via one of the following methods:
- Secure Workers’ Compensation Submission Form (an OnBase/PolyDoc form)
- Please log in using your Cal Poly Pomona credentials (BroncoName and password)
- Once you have logged in please upload your completed Personal Physician Pre-Designation Form (documentation) as prompted
- Sealed inter-office mail (marked as Confidential)
- In-person to the HR Customer Service Center in the Student Services Building 121, Second Floor
General Inquiries
Hours: 8:00 AM - 5:00 PM I Email: hrscsc@cpp.edu I Phone: 909-869-3733
3801 W. Temple Ave, Pomona, CA 91768
Student Services Building 121, Second Floor
Map and Directions to our office
Map and Directions to our office