Independent Medical Examination Fax Cover Sheet


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Title Independent Medical Examination Fax Cover Sheet
Description Independent Medical Examination Fax Cover Sheet
Document number F245-383-000
How to get this document
  • Download (93 KB Fillable PDF) 

  • Call L&I's Electrical Program, 360-902-5269. Please provide the document number so we can process your request quickly. The title is also helpful.
Keywords cover, fax, fax, IME, independent, independent medical examiner, independent medical exams
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Valid dates 12/2008
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