Statement for Home Nursing Services

Document Information
  How to complete a fillable form.
Title Statement for Home Nursing Services

Used to bill L&I for reimbursement of home nursing services.

Document number F248-160-000
How to get this document
Alt Language(s)
Valid dates 11/2013
Contact information Claims for Job Injuries, Employer Services, Employer Services, Employer Services
Websites For Medical Provider

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