Statement for Miscellaneous Services
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| Información del documento | ||
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| Título |
Statement for Miscellaneous Services (Un formulario electrónico)- 187 KB PDF) |
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| Descripción | This bill form is used by providers and injured workers to bill the department for services such as dental care; glasses; medical equipment; nursing home services; interpreter services; services workers pay for out of pocket; and other services. Information on how to bill the department can be found in the General Provider Billing Manual (F248-100-000).
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| Detalle | ||
| Número del formulario | F245-072-000 | |
| Disponibilidad | ordénelo | |
| Palabras claves | claims, eye glasses, home services, industrial insurance, orthotics, prosthetics, retraining, transportation, worker's compensation, workers compensation, workers' compensation | |
| Idiomas | English, Spanish | |
| Fechas válidas | 04-2010 | |
| Contacto |
Managing Injured Workers' Claims
Vocational Resources |
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| Páginas de Internet | For Medical Providers | |
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