Attending Provider's Referral Form

Información del documento
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Título

Attending Provider's Referral Form

(108 KB DOC)
Descripción

Attending Providers send this form to refer injured workers for medical opinion consultations, specialty/surgical consultations, concurrent care (authorization required), transfer of care consultation, or closing exam and impairment rating. Give a copy of the completed form to the injured worker.

Detalle
Número del formulario F252-098-000
Disponibilidad solicítelo
Palabras claves Consultation, obtain consultations, obtain or make referrals, referral, second opinion
Idiomas
Fechas válidas 10-2013
Contacto Managing Injured Workers' Claims
Claims for Job Injuries
Páginas de Internet For Medical Providers

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