Transfer of Attending Provider Form for Self Insured Workers
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| Título |
Transfer of Attending Provider Form for Self Insured Workers (48 KB DOC) |
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| Descripción | This form is used by self-insured injured workers who want to transfer their medical care. Self-insured workers should complete the form and send it to their employer or their Third Party Representative. |
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| Detalle | ||
| Número del formulario | F207-114-000 | |
| Disponibilidad | ordénelo | |
| Palabras claves | attending doctor, attending provider, change doctor, doctor, provider, self insurance, transfer, transfer of care, Transfer of Care | |
| Idiomas | English, Spanish | |
| Fechas válidas | 11-2012 | |
| Contacto |
Self-Insurance
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