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Account Deposit for Factory Assembled Structures Account Holders
Form
F622-081-000  
Activity Prescription Form (APF)
Form
F242-385-000  
Affidavit of Continuity Medical Gas Installation
Form
F627-043-000  
Application for Insignia Conversion Vendor/Medical Units
Form
F623-021-000  
Application for Plumber Examination, Reciprocal, Medical Gas Endorsement, or Temporary Permit
Form
F627-008-000  
Application for Loss of Earning Power (LEP) - Compensation Medical
Form
F242-208-000

World Language(s):
English/Español
Español  
Application to Establish an Factory Assembled Structure Deposit Account with the Dept. of Labor and Industries
Form
F120-116-000  
Approved Independent Medical Examiner (IME) Update
Form
F245-051-000  
Approved Independent Medical Examiner (IME) Update
Form
F245-051-000  
CMS 1500
Form
F245-127-000  
CMS 1500
Form
F245-127-000  
Crime Victims Statement for Home Nursing Services
Form
F800-070-000  
Crime Victims Statement for Pharmacy Services
Form
F800-058-000  
Crime Victims Statement for Pharmacy Services
Form
F800-058-000  
Independent Medical Exam Doctor's Estimate of Physical Capacities
Form
F242-387-000  
Independent Medical Exam Template
Form
F245-058-000  
Independent Medical Examination (IME) Provider Exam Sites
Form
F245-047-000  
Independent Medical Examination (IME) Provider Exam Sites
Form
F245-047-000  
Independent Medical Examination (IME) Provider Exam Sites
Form
F245-047-000  
Independent Medical Examination Fax Cover Sheet
Form
F245-383-000  
Independent Medical Examination Fax Cover Sheet
Form
F245-383-000  
Logging Emergency Medical Plan (Logging Safety and Health Meetings)
Form
F417-014-000  
Medical Device Review Request
Form
F252-013-000  
Medical Device Review Request
Form
F252-013-000  
Medical Examiners' Handbook
Publication
F252-001-000  
Medical Examiners' Handbook
Publication
F252-001-000  
Need a Doctor?
Publication
F160-006-000

World Language(s):
Español  
Need a Doctor?
Publication
F160-006-000

World Language(s):
Español  
Non-Network Provider Application
Form
F248-011-000  
Notice of Independent Medical Exam No-Show or Late Cancellation
Form
F245-382-000  
Notice of Independent Medical Exam No-Show or Late Cancellation
Form
F245-382-000  
Occupational Disease & Employment History
Form
F242-071-000

World Language(s):
Español  
Occupational Disease Work History - Continuation
Form
F242-071-111

World Language(s):
Español  
Out of Country Provider Application
Form
F248-361-000

World Language(s):
Español  
Plumber, Medical Gas, or Trainee Renewal
Form
F627-019-000  
Provider Account Application - Independent Medical Examiner (IME)
Form
F245-046-000  
Provider's Initial Report (PIR)
Form
F207-028-000  
Provider's Initial Report (PIR)
Form
F207-028-000  
Provider's Request for Adjustment
Form
F245-183-000  
Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease
Form
F242-130-000

World Language(s):
Español  
Safety Standards for WAC 296-802, Employee Medical and Exposure Record
Manual
F414-122-000  
Self-Insurance Medical Provider Billing Dispute Form
Form
F207-207-000  
Self-Insurance Medical Provider Billing Dispute Form
Form
F207-207-000  
Self-Insurance Medical Provider Billing Dispute Form
Form
F207-207-000  
Self-Insurer Accident Report (SIF-2)
Form
F207-002-000  
Transfer of Care Card
Form
F245-037-000

World Language(s):
Español  
Travel Reimbursement Request
Form
F245-145-000

World Language(s):
Español  
Vendor / Medical Conversion Units Pre-Inspection Checklist
Form
F622-072-000  
Vocational Training Plan Ownership Agreement for Tools and Equipment
Form
F245-351-000

World Language(s):
Español  
Your Independent Medical Exam
Form
F245-224-000

World Language(s):
Español  
Your Independent Medical Exam
Publication
F245-224-000

World Language(s):
Español  
Application for Loss of Earning Power Compensation Medical / Solicitud para compensación por reducción de ingresos (médicos) (English/Spanish)
Form
F242-208-909

World Language(s):
Inglés
Español  
Attending Provider's Return-to-Work Desk Reference
Publication
F200-002-000  
Comentarios Sobre el Exámen Médico Independente
Form
F245-053-999

World Language(s):
Inglés  
Comentarios Sobre el Exámen Médico Independente
Form
F245-053-999

World Language(s):
Inglés  
Continuación del Historial de Trabajo y de Enfermedad Ocupacional
Form
F242-071-911

World Language(s):
Inglés  
Facts about Medical Gas Piping Installer Endorsement
Publication
F627-026-000  
Heat-related Illness Education Card/ Tarjeta de educación sobre enfermedades relacionadas con el calor (English/español)
Publication
F417-218-909  
Historial de trabajo (enfermedad ocupacional)
Form
F242-071-999

World Language(s):
Inglés
Español  
Hotline Tips for Medical Services Providers
Publication
F248-040-000  
Independent Medical Exam Comments
Form
F245-053-000

World Language(s):
Español  
Medical Payment Guidance
Publication
F248-366-000  
Pocket Guide to Worker Rights / Guía de bolsillo sobre los derechos del trabajador (English/español)
Publication
F101-165-909

World Language(s):
Inglés  
Provider Network Agreement
Form
F245-397-000  
RCW 43.22.380 Exemptions Fire and Safety Checklist for Vendor/Medical Conversion Units
Form
F622-073-000  
Solicitud para compensación por reducción de ingresos (médico)
Form
F242-208-999

World Language(s):
Inglés
English/Español  
Su examen médico independiente: para empleadores de negocios autoasegurados
Publication
F207-202-999

World Language(s):
Inglés  
Su examen médico independiente: para empleadores de negocios autoasegurados
Publication
F207-202-999

World Language(s):
Inglés  
Tarjeta para transferencia de caso
Form
F245-037-999

World Language(s):
Inglés  
Your Independent Medical Exam (IME): Crime Victims Compensation Program
Publication
F800-115-000  
Your Independent Medical Exam: For Employees of Self-Insured Businesses
Publication
F207-202-000

World Language(s):
Español  





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