Tarjeta para transferencia de caso

Document Information
  How to complete a fillable form.
Title Tarjeta para transferencia de caso

Usada por los trabajadores lesionados para notificar al gerente de reclamo y solicitar autorización para transferir el cuidado a un doctor diferente.

Document number F245-037-999
How to get this document
Alt Language(s) English
Valid dates 04/2014
Contact information Claims for Job Injuries, Managing Injured Workers' Claims
Websites For Medical Providers, Workers' Comp Claims

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.