Obtenga un formulario o publicación: clinical
Su búsqueda de "clinical" consiguió 8 resultados.
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| Título | Tipo | Número |
|---|---|---|
Physical Therapy / Occupational Therapy Progress Report to Claim Managers The physical / occupational therapist uses this report to identify the clinical goals and return to work objectives of the injured worker. |
Form | F245-059-000 |
| Consultation or Referral
The attending doctor refers an injured worker for consultation for clinical issues, 120 day consultation and/or closing, etc. |
Form | F245-299-000 |
| Crime Victims Compensation Program Initial Response and Assessment: Form I
Used by the clinical provider to get approval to see a victim for six sessions or less. If more than six sessions, please complete Form II (F800-081-000). |
Form | F800-080-000 |
| Crime Victims Compensation Program Initial Response and Assessment: Form II
Used by the clinical provider to request authorization to provide more than six sessions. This form must be submitted by the sixth session. (6 pages) |
Form | F800-081-000 |
| Crime Victims Compensation Program Progress Note: Form III
Used by the clinical provider to submit a request for preauthorization for payment of additional sessions. |
Form | F800-082-000 |
| Crime Victims Compensation Program Termination Report: Form VI
Used by the clinical provider to inform L&I that you are no longer conducting treatment to the client. This must be submitted within 60 days of the client's last session and you are no longer conducting treatment. |
Form | F800-085-000 |
| Crime Victims Compensation Program Treatment Report: Form V
Used by the clinical provider to get preauthorization for payment of additional sessions. |
Form | F800-084-000 |
| Crime Victims Compensation Program Treatment Report: Form IV
Used by the clinical provider to request preauthorization for payment of additional sessions. |
Form | F800-083-000 |
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