Statement for Pharmacy Services

Document Information
  How to complete a fillable form.
Title Statement for Pharmacy Services (English)
Document number F245-100-000
Document type Form
How to get this document
  • Order it from our Warehouse

  • Check for alternate languages of this document
    Valid dates 02/2019
    Contact information Claims for Job Injuries , Managing Injured Workers' Claims
    Related information
    Documents Crime Victims Statement for Pharmacy Services
    Statement for Compound Prescription
    Websites For Medical Providers

    End of main content, page footer follows.

    Access Washington official state portal

       © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.

    Help us improve