Get a Form or Publication: reapplication
Your search for "reapplication" returned 1 documents.
See also
| Title | Type | Number |
|---|---|---|
| Provider Account Application - Independent Medical Examiner (IME)
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. |
Form | F245-046-000 |
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