Application and instructions for a Washington State electrician's certificate examination.

Provides information health-care providers need to bill the Crime Victims Compensation Program for medical services.

Book: A publication for independent medical examiners, attending doctors and consultants, this document contains guidelines, sample reports and billing procedures for preparing and conducting impairment ratings and independent medical exams in Washington's workers' compensation system. Beginning July 1, 2012, free Category I CME credits are available for completing the self-assessment associated with this handbook. Go to www.Imes.Lni.wa.gov and click on Medical Examiners Handbook for information on the exam. L&I and the authors have no financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this document.

The 2013 Plumber Examination Dates and Locations. A printed version is also available from the L&I Warehouse.

In order to do independent medical exams a provider must obtain a provider account number with L&I. This packet includes the application and agreement with instructions, IME Provider Exam sites form (F245-047-000) and Request for Taxpayer ID and Certification - Form W-9 (F248-036-000) (10 pages). If you have questions, please email balk235@lni.wa.gov or call 360-902-6815.

The purpose of the manufactured home roof affidavit is to provide timely inspections and communications between the contractor and/or owner and FAS inspectors and field staff.

A structural inspection request questionnaire will not be required when a roof change out occurs if no structural changes are made in the roof sub-surface and roof cavity. Example: Repairing or replacing the roof trusses, rafters, ridge beam and the replacement of not more than (4) 4’x 8’ of roof sheathing.

This form is used to apply for plumber examination, reciprocal and medical gas endorsement.

Covers 03A, 06B, 07A, 07B, 07C, 07D, 07E, and 10 specialty licenses.

EXAMPLE ONLY: Example of an application to apply for an apprenticeship. Registered Apprenticeship Programs use their own forms. NOT TO BE USED TO REQUEST PLUMBER or ELECTRICAL TRAINEE CARD.

This form is used to apply for the backflow specialty examination.

To apply for a certificate of competency as an Inspector of Pressure Retaining items. You can only mail or fax this form to L&I. Emailed forms are not accepted. NOTE: Applications MUST be received no later than 30 days prior to the exam date. Incomplete applications WILL NOT be accepted.

Use this form to apply for the master electrician exam.

Used for creating combination electrical and plumbing contractors license

Example: Used for tracking applicants for an apprenticeship program. Registered Apprenticeship Programs use their own forms.

To update or correct the IME's contact, availability, qualificaitons and/or exam sites.

Used by the injured worker to provide comments to L&I about their recent medical exam by an IME.

A form used by physicians, hospitals and clinics to provide information and reporting to the Crime Victims Compensation Program.

Fact sheet: Explains plumber classifications, certification requirements, including required exams, and the application and renewal processes, including continuing education requirements.

Used by the injured worker to provide comments to L&I about their recent medical exam by an IME.

IME Doctor’s Estimate of Physical Capacities: For use by independent examiners when asked to estimate physical capacities as part of an IME requested by the department.

Template used by a doctor during an independent medical exam.

List the locations where the doctor does independent medical exams on a regular basis.

Independent Medical Examination Fax Cover Sheet

This application is for doctors applying for second opinion examiner (consultant) status. Current consultants do not need to reapply.

Used to order L&I medical forms.

Example of how the minutes for an Apprenticeship Committee meeting should be recorded. Submit this to L&I Apprenticeship section within 30 days of the meeting.

Use this form for noting any deficiencies of cranes, derricks, material handling devices, spouts, suckers and similar equipment.

Notice of Independent Medical Exam No-Show or Late Cancellation

This form is used by applicants applying for a charter boat operators license to have completed by a physician for an operators license

Sample of a letter a return to work person would use to assist L&I in determining whether services or funds should be authorized to assist them in becoming self-employed.

If you are considered a victim of crime, use this form to track your travel expenses for medical, retraining or vocational services or for an independent medical exam. You should have approval from your claim manager before you travel.

Pamphlet/booklet: Answers the most common questions about independent medical exams and when and why an injured worker may be required to receive one. Includes the "IME Travel & Wage Reimbursement Request" form.

Pamphlet/booklet: Answers the most common questions about independent medical exams and when and why an injured worker may be required to receive one. Includes the "IME Travel & Wage Reimbursement Request" form.

Fact Sheet: Provides answers to commonly asked questions about independent medical exams (IMEs) and contact information. Includes a form for requesting travel-related reimbursement for attending an IME.

Pamphlet: Answers the most common questions about when and why an injured worker may be required to attend an independent medical exam. Includes the "IME Travel & Wage Reimbursement Request" form. This publication is for use only by self-insured businesses and their workers.

Pamphlet: Answers the most common questions about when and why an injured worker may be required to attend an independent medical exam. Includes the "IME Travel & Wage Reimbursement Request" form. This publication is for use only by self-insured businesses and their workers.