Transfer of Attending Provider Form for Self Insured Workers


Document Information
  How to complete a fillable form.
Title Transfer of Attending Provider Form for Self Insured Workers
Document number F207-114-000
How to get this document
  • Call the Self-Insurance Section of L&I, 360-902-6898 or fax your request to 360-902-6977. Please have the document number ready so we can process your request quickly. The title is also helpful.
  • Alt Language(s) Español
    Valid dates 11/2012
    Contact information Self-Insurance
    Websites

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