Statement for Retraining and Job Modification Services

Información del documento
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Título

Statement for Retraining and Job Modification Services

(Un formulario electrónico)- 156 KB PDF)
Descripción

Bill form for providers that bill the department for claim-related retraining and job modification services. See the General Provider Billing Manual (248-100-000) for information on completing this form.

Detalle
Número del formulario F245-030-000
Disponibilidad solicítelo
Palabras claves injured worker, provider, rehab, rehabilitation, reimbursement, self-insurance, self-insurer, workers compensation, workers' compensation
Idiomas English
Fechas válidas 08-2013, 03-2014
Contacto Managing Injured Workers' Claims
Claims for Job Injuries
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