Obtenga un formulario o publicación: eye glasses
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| Título | Tipo | Número |
|---|---|---|
Statement for Miscellaneous Services Also available in: Spanish 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).
|
Form | F245-072-000 |
| Instructions in Spanish for completing the form F245-072-000 Statement for Miscellaneous Services
Also available in: English Instructions in Spanish for completing the form F245-072-000 Statement for Miscellaneous Services |
Form | F245-072-999 |
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