| Document Information | ||
|---|---|---|
Get help downloading & printing files. |
||
| Title | ||
| Description | Filled out by the provider when they treat an injured worker. See web links below for: Latest payment amounts, Updates and corrections, and Review payment policy. For use in place of Minimum Data Set (MDS) 2.0 through September 30, 2011. Use F245-392-000 in place of MDS 3.0 beginning October 1, 2010. | |
| Detail | ||
| Form number | F245-052-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | ||
| Languages | English | |
| Valid dates | All dates valid | |
| Contact information | ||
Please take this survey to help improve the L&I website.
Take survey
(About 3 minutes)
© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.