Medical Device Review Request

Medical Device Review Request - (Forms/Publications)
Document Information
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Title Medical Device Review Request (A fillable form - 116 KB PDF)

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.

Form number F252-013-000
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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