Employer Services Authorization Form

This form authorizes Owensboro Health clinicians to provide such medical and/or surgical services as may be necessary to properly care for the injury/illness diagnosed or to perform the service indicated to the named employee for the purpose of medical surveillance or review, any occupational exams or preventive health services, drug and alcohol testing, or other service as defined under occupational medicine. The employer assumes full responsibility for all charges incurred for the services rendered.

Locations

Owensboro Health Occupational Medicine
2211 Mayfair Ave., Suite 102 
Owensboro, KY 42301 
Monday - Friday, 8 a.m. to 4 p.m.
Call: 270-688-1351 
Fax: 270-683-3420

Owensboro Health Regional Hospital 
Emergency Services/Post-Incident/Reasonable Suspicion 
1201 Pleasant Valley Road
Owensboro, KY 42303 
Open 24/7. Call ahead for service after 8 p.m.
Call: 270-417-4338 

Owensboro Health Madisonville Healthplex 
Occupational Medicine/Urgent Care 
510 Ruby Drive
Madisonville, KY 42431 
Monday - Friday, 8 a.m. to 8 p.m., Saturday - Sunday, 8 a.m. to 5 p.m.
Call: 270-399-7900 
Fax: 270-399-7910 

Owensboro Health Occupational Medicine
No Imaging services onsite 
27 E. Highway 66 
Tell City, IN 47586 
Monday - Friday, 7:30 a.m. to 4 p.m.
Call: 812-395-2011 

Owensboro Health Henderson Healthplex 
1200 Barret Blvd. 
Henderson, KY 42420 
Monday - Friday, 7 a.m. to 8 p.m., Saturday - Sunday 8 a.m. to 5 p.m.
Call: 270-844-8600 
Fax: 270-844-8610

Owensboro Health Muhlenberg Healthplex 
2025 W. Everly Brothers Blvd. 
Powderly, KY 42367 
Monday - Friday, 7 a.m. to 8 p.m., Saturday - Sunday 8 a.m. to 5 p.m.
Call: 270-377-2405 
Fax: 270-377-2406

Owensboro Health Twin Lakes Medical Center 
Emergency Services/Post-Incident/Reasonable Suspicion 
910 Wallace Ave. 
Leitchfield, KY 42754
Open 24/7
Call: 270-259-9400 

Owensboro Health Urgent Care 
No imaging services onsite 
1895 Elizabethtown Road 
Leitchfield, KY 42754 
Monday - Friday, 8 a.m. to 4:30 p.m.
Call: 270-230-0182 
Fax: 270-230-1420

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