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Results for: Claims and Insurance - Medical Provider Claim Management
Title:

Type:

3 Things to Know about L&I's Medical Provider Network


Publication
F242-406-000

World Language(s):
Español
 
Activity Prescription Form (APF)


Form
F242-385-000
 
Attending Doctor's Handbook


Publication
F252-004-000
 
Certificado de cobertura - ejemplo


Form
F211-141-999

World Language(s):
Inglés
 
Common Errors on the Interpretive Services Appointment Record (ISAR)


Publication
F245-436-000
 
Doctor's Worksheet for Rating Cervical and Cervico-Dorsal Impairment


Form
F252-056-000
 
Doctor's Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment


Form
F252-006-000
 
Functional Capacity Summary


Form
F245-434-000
 
Functional Recovery Interventions Tracking Sheet


Publication
F245-420-000
 
Hearing Impairment Calculation Worksheet


Form
F252-007-000
 
Hearing Services Worker Information


Form
F245-049-000
 
Independent Medical Exam Doctor's Estimate of Physical Capacities


Form
F242-387-000
 
Interpretive Services Appointment Record (ISAR)


Form
F245-056-000
 
Job Modification Assistance Application


Form
F245-346-000

World Language(s):
Español
 
Labor and Industries Prosthetic Device Request Form


Form
F245-340-000
 
Long Term Care Assessment Tool


Form
F245-377-000
 
Medical Examiners' Handbook


Publication
F252-001-000
 
Notice of Occupational Disease or Infection


Form
F242-243-000
 
Notificación de decisión de cierre para reclamos de tiempo perdido para empleadores autoasegurados


Form
F207-070-999

World Language(s):
Inglés
 
Out of Country Provider Application


Form
F248-361-000

World Language(s):
Español
 
Physical Therapy / Occupational Therapy Progress Report to Claim Managers


Form
F245-059-000
 
Pre-Job Accommodation Assistance Application


Form
F245-350-000
 
Preauthorization Request for Services for State Fund Workers' Compensation Patients


Form
F242-397-000
 
Provider's Initial Report (PIR)


Form
F207-028-000
 
Provider's Request for Adjustment


Form
F245-183-000
 
Solicitud de cuenta para proveedores fuera del país


Form
F248-361-999

World Language(s):
Inglés
 
Statement for Miscellaneous Services


Form
F245-072-000

World Language(s):
Español
 
Statement for Retraining and Job Modification Services


Form
F245-030-000

World Language(s):
Español
 
Submission of Provider Credentials for Interpretive Services


Form
F245-055-000
 
Tarjeta para transferencia de caso


Form
F245-037-999

World Language(s):
Inglés
 
Termination of Agreement (Rescission)


Form
F245-050-000
 
Transfer of Care Card


Form
F245-037-000

World Language(s):
Español
 
Tres cosas que debe conocer sobre la Red de proveedores médicos de L&I


Publication
F242-406-999

World Language(s):
Inglés
 
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
 
Attending Provider's Return-to-Work Desk Reference


Publication
F200-002-000
 
Hotline Tips for Medical Services Providers


Publication
F248-040-000
 
Medical Payment Guidance


Publication
F248-366-000
 





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