Statement for Retraining and Job Modification Services

Statement for Retraining and Job Modification Services - (Forms/Publications)
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Title Statement for Retraining and Job Modification Services (A fillable form - 156 KB PDF)
Description

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.

Detail
Form number F245-030-000
Availability
Order it
Keywords injured worker, provider, rehab, rehabilitation, reimbursement, self-insurance, self-insurer, workers compensation, workers' compensation
Languages English
Valid dates 08-2013 , 03-2014
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Related information
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Option 2 Vocational Benefits Training Enrollment Application and Verification


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