Medical Device Review Request
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
Medical Device Review Request (A fillable form - 116 KB PDF)
|
|
| Description | This form is so L&I's Office of the Medical Director can evaluate medical device(s) that the attending physican wants to use to treat an injured worker. | |
| Detail | ||
| Form number | F252-013-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | attending doctor, attending physician, injured worker, medical device, medical forms, physician assistant, provider | |
| Languages | English | |
| Valid dates | 04-1997 | |
| Contact information |
Claims for Job Injuries
Treating Injured Workers |
|
| Web pages | For Medical Providers | |
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