UB04 HCFA 1450

Document Information
  How to complete a fillable form.
Title UB04 HCFA 1450
Document number F245-367-000
How to get this document
Alt Language(s)
Valid dates
Contact information Claims for Job Injuries
Websites For Medical Providers

End of main content, page footer follows.

Access Washington official state portal

  © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.

Help us improve