Authorization For Treatment
Pelican State Urgent Care
1525 Dickory Ave., Harahan, LA 70123
Monday - Friday, 8 a.m. to 11 p.m.
Saturday - Sunday, 9 a.m. to 5 p.m.
Fields marked with an asterisk(*) are required.
Please note: Upon form completion, EJGH will forward your employee's information to Pelican State Occupational Medicine. They will be providing any applicable evaluations, treatments, and return to work status letters.