Forms and Publications

Search by:   for     

Browse By Subject  |  Most Requested  |  Required L&I Workplace Posters  |  Spanish Language Documents  |  Show all L&I Forms/Pubs


View:    Sort by:       
Title:

Type:

3 Things to Know about L&I's Medical Provider Network
Publication
F242-406-000

World Language(s):
Español  
Assessment Eligible Quality Assurance Review Form
Form
F280-008-000  
CMS 1500
Form
F245-127-000  
Crime Victim Compensation Program Sexual Assault Exam Report
Form
F800-098-000  
Crime Victims Direct Entry Billing Manual
Manual
F800-118-000  
Crime Victims Direct Entry Billing Manual
Manual
F800-118-000  
Crime Victims' Statement for Compound Prescription
Form
F800-067-000  
Crime Victims' Statement for Compound Prescription
Form
F800-067-000  
Electronic Billing Authorization
Form
F248-031-000  
Individual Vocational Provider Account Change Form
Form
F252-021-000  
Individual Vocational Provider Account Change Form
Form
F252-021-000  
Job Modification Assistance Application
Form
F245-346-000

World Language(s):
Español  
Job Modification Assistance Application
Form
F245-346-000

World Language(s):
Español  
Medical Device Review Request
Form
F252-013-000  
Need a Doctor?
Publication
F160-006-000

World Language(s):
Español  
Non-Accredited or Unlicensed Training Provider Application Supplemental Requirements
Form
F280-045-000  
Non-Network Provider Application
Form
F248-011-000  
Non-Network Provider Application
Form
F248-011-000  
Non-Network Provider Application
Form
F248-011-000  
OJT Information Request and Recommendation form
Form
F280-032-000  
On-The-Job Training (OJT) Agreement for Vocational Providers
Form
F280-039-000  
Option 2 Vocational Benefits Training Enrollment Application and Verification
Form
F280-024-000

World Language(s):
English/Español  
Out of Country Provider Application
Form
F248-361-000

World Language(s):
Español  
Out of Country Provider Application
Form
F248-361-000

World Language(s):
Español  
Out of Country Provider Application
Form
F248-361-000

World Language(s):
Español  
Overpayment Reimbursement Fund Request Coversheet
Form
F207-212-000  
Plan Development Quality Assurance Review Form
Form
F280-007-000  
Plan Room and Board Cost Encumbrance
Form
F245-372-000  
Provider Account Application - Independent Medical Examiner (IME)
Form
F245-046-000  
Provider Change Form for Crime Victims Compensation
Form
F800-089-000  
Provider Payment Account Change Form
Form
F245-365-000  
Provider's Initial Report (PIR)
Form
F207-028-000  
Provider's Initial Report (PIR)
Form
F207-028-000  
Provider's Request for Adjustment
Form
F245-183-000  
PT/OT Referral Form
Form
F252-099-000  
Quick Reference Card for Providers 2015
Publication
F245-414-000_2015  
Sample Format for Vocational Evaluation Testing Plan
Form
F252-052-000  
Sample Format for Vocational Testing Report
Form
F252-051-000  
Self-Insurance Medical Provider Billing Dispute Form
Form
F207-207-000  
Self-Insurance Medical Provider Billing Dispute Form
Form
F207-207-000  
Self-Insurance Vocational Reporting Form
Form
F207-190-000  
Statement for Retraining and Job Modification Services
Form
F245-030-000

World Language(s):
Español  
Statewide Payee Registration and W-9 Form Crime Victims
Form
F800-065-000  
Statewide Payee Registration and W-9 Form
Form
F248-036-000  
Statewide Payee Registration and W-9 Form
Form
F248-036-000  
Submission of Provider Credentials for Interpretive Services
Form
F245-055-000  
Submission of Provider Credentials for Interpretive Services
Form
F245-055-000  
Time Encumbrance Form
Form
F245-376-000  
Training Plan Cost Encumbrance
Form
F245-374-000  
Transfer of Attending Provider Form for Self Insured Workers
Form
F207-114-000

World Language(s):
Español  
Transfer of Attending Provider Form for Self Insured Workers
Form
F207-114-000

World Language(s):
Español  
Transfer of Care Card
Form
F245-037-000

World Language(s):
Español  
Transportation Cost Encumbrance
Form
F245-375-000  
Travel Reimbursement Request
Form
F245-145-000

World Language(s):
Español  
Vocational Provider Application
Form
F252-088-000  
Vocational Questionnaire/Work History
Form
F280-038-000

World Language(s):
Español  
Vocational Training Plan Ownership Agreement for Tools and Equipment
Form
F245-351-000

World Language(s):
Español  
Vocational Training Plan Ownership Agreement for Tools and Equipment
Form
F245-351-000

World Language(s):
Español  
Washington Practitioner Application
Form
F245-411-000  
WISHA Occupational Exposure to Bloodborne Pathogens - Chapter 296-823 WAC
Manual
F414-073-000  
Carrying Out Your Vocational Plan: Your Rights and Responsibilities During Plan Implementation
Publication
F280-019-000

World Language(s):
Español  
Cuestionario Vocacional/Historia de trabajo
Form
F280-038-999  
Formulario para trasferencia de proveedor principal para trabajadores autoasegurados
Form
F207-114-999

World Language(s):
Inglés  
Hotline Tips for Medical Services Providers
Publication
F248-040-000  
Master Level Counselor Provider Account Application for Crime Victims
Form
F800-053-000  
Option 2 Vocational Benefits Training Enrollment Application/Solicitud y verificación del registro para capacitación de beneficios vocacionales opción 2 (English/español)
Form
F280-024-909

World Language(s):
Inglés  
Provider Network Agreement
Form
F245-397-000  
Self-Insurance Vocational Services Closing Cover Sheet
Form
F207-171-000  
Tarjeta para transferencia de caso
Form
F245-037-999

World Language(s):
Inglés  
Tres cosas que debe conocer sobre la Red de proveedores médicos de L&I
Publication
F242-406-999

World Language(s):
Inglés  
Workers' Comp Fraud Hurts YOU
Publication
F262-279-000  





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