Statement for Retraining and Job Modification Services
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
Statement for Retraining and Job Modification Services (A fillable form - 275 KB PDF)
|
|
| Description | Bill form for providers that bill the department for claim-related retraining and job modification services. See the Retraining and Job Modification Billing Instructions (F248-015-000) for information on completing this form. | |
| Detail | ||
| Form number | F245-030-000 | |
| Availability | Order it |
|
| Keywords | injured worker, provider, rehab, rehabilitation, reimbursement, self-insurance, self-insurer, workers compensation, workers' compensation | |
| Languages | English | |
| Valid dates | 02-2011 , 04-2010 | |
| Contact information |
Managing Injured Workers' Claims
Claims for Job Injuries |
|
| Related information | ||
| Documents | Option 2 Vocational Benefits Training Enrollment Application and Verification |
|
| Web pages | For Medical Providers | |
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