Crime Victims Compensation Subacute Opioid Request Form


Document Information
  How to complete a fillable form.
Title Crime Victims Compensation Subacute Opioid Request Form
Description

Use this form for Crime Victims Compensation to request opioid coverage between 6 weeks and 12 weeks from date of injury or surgery.

Document number F800-119-000
How to get this document
Alt Language(s)
Valid dates 01/2015
Contact information Claims and Insurance
Websites

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