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Title Number / Language
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3 Things to Know about L&I's Medical Provider Network  F242-406-000 (English)
 F242-406-999 (Spanish)
Affidavit of Continuity Medical Gas Installation  F627-043-000 (English)
Application for Insignia Conversion Vendor/Medical Units  F623-021-000 (English)
Application for Loss of Earning Power Compensation Medical  F242-208-909 (English/Spanish)
 F242-208-999 (Spanish)
Application for Plumber Examination, Reciprocal, Medical Gas Endorsement, or Temporary Permit  F627-008-000 (English)
Application for Loss of Earning Power (LEP) - Compensation Medical  F242-208-000 (English)
Approved Independent Medical Examiner (IME) Update  F245-051-000 (English)
Facts about Medical Gas Piping Installer Endorsement  F627-026-000 (English)
Hearing Aid Repair/Durable Medical Equipment Provider Hotline Service Authorization Request  F245-418-000 (English)
Helpful Tips for Medical Services Providers  F248-040-000 (English)
Independent Medical Exam Comments  F245-053-000 (English)
 F245-053-999 (Spanish)
Independent Medical Exam Doctor's Estimate of Physical Capacities  F242-387-000 (English)
Independent Medical Exam Template  F245-058-000 (English)
Independent Medical Examination (IME) Provider Exam Sites  F245-047-000 (English)
Independent Medical Examination Fax Cover Sheet  F245-383-000 (English)
L&I Medical Provider Network Credentialing Checklist  F245-445-000 (English)
Logging Emergency Medical Plan  F417-014-000 (English)
Medical Device Review Request  F252-013-000 (English)
Medical Examiners' Handbook  F252-001-000 (English)
Medical Payment Guidance  F248-366-000 (English)
Notice of Independent Medical Exam No-Show or Late Cancellation  F245-382-000 (English)
Plan Approval Request - Conversion Vendor / Medical Units  F622-035-000 (English)
Plumber, Medical Gas, or Trainee Renewal  F627-019-000 (English)
Provider Account Application - Independent Medical Examiner (IME)  F245-046-000 (English)
RCW 43.22.380 Exemptions Fire and Safety Checklist for Vendor/Medical Conversion Units  F622-073-000 (English)
Safety Standards for WAC 296-802, Employee Medical and Exposure Record  F414-122-000 (English)
Self-Insurance Medical Provider Billing Dispute Form  F207-207-000 (English)
Self-Insured Employers' Medical Only Claim Closure Order and Notice  F207-020-111 (English)
 F207-020-999 (Spanish)
Vendor / Medical Conversion Units Pre-Inspection Checklist  F622-072-000 (English)
Your Independent Medical Exam  F245-224-000 (English)
 F245-224-999 (Spanish)
Your Independent Medical Exam (IME): Crime Victims Compensation Program  F800-115-000 (English)
Your Independent Medical Exam: For Employees of Self-Insured Businesses  F207-202-000 (English)
 F207-202-999 (Spanish)





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