Sequoia Hospital/CHW OCCUPATIONAL MEDICINE/URGENT CARE "Serving the Business Community"
633 Veterans Blvd. Redwood City, CA 94063 650.364.1565 FAX 650.366.2590 Open Monday – Friday, 8:00am to 6:00 pm; Saturday 9:00 am to 1:00 pm
MAP TO FACILITY AND AUTHORIZATION WITHOUT STANFORD I.D. CARD N
To Sequoia Hospital
Whipple Exit
Interstate 101 Veterans
Directions Driving South on Veterans Go past Whipple Ave U-turn at Brewster Turn right at 633 Veterans Building Driving North on Veterans Pass Main St., then Brewster Avenue Turn right at 633 Veterans Building
Industrial
Whipple Avenue
Sequoia Occupational Health/Urgent Care 633 Veterans Blvd.
Price Ave. Convention Way Convention Way
El Camino
To I-280
Brewster Avenue Main Street Woodside Road
Patient Name Stanford University
Occupation or Relationship to Stanford
Phone
Employer/Business Name
Zurich North America, Fax No.: (415) 296-7368 Insurance Carrier Requested Services
W/C Injury/Illness Preplacement Physical Drug Screen Immunization Other
Modified Work for This Employee is
Available Not Available Special Instructions Company Authorization by: Supervisor Fax Number: Appointment Date: Time: Title: Date:
Medical Care Authorization Word 2/02/04
Medical Care Authorization Word 2/02/04