Labor and Industries Prosthetic Device Request Form
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
 Labor and Industries Prosthetic Device Request Form (107 KB PDF)
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|
| Description | Labor and Industries Prosthetic Device Request Form | |
| Detail | ||
| Form number | F245-340-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | device, prosthetics, request | |
| Languages | English | |
| Valid dates | 10-2009 | |
| Contact information |
Healthcare Treatment Guidelines/Information
Provider Feedback |
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| Web pages | ||
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