Provider Account Application - Independent Medical Examiner (IME)

Provider Account Application - Independent Medical Examiner (IME) - (Forms/Publications)
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Title Provider Account Application - Independent Medical Examiner (IME) (A fillable form - 757 KB PDF)
Description

In order to do independent medical exams a provider must obtain a provider account number with L&I. This packet includes the application and agreement with instructions, IME Provider Exam sites form (F245-047-000) and Request for Taxpayer ID and Certification - Form W-9 (F248-036-000) (10 pages). If you have questions, please email balk235@lni.wa.gov or call 360-902-6815.

Detail
Form number F245-046-000
Availability
Online only. See document above to download.
Keywords doctor, exams, medical, physician, provider application, reapplication
Languages English
Valid dates 02-2013
Contact information Independent Medical Examiners
Related information
Documents

Independent Medical Examination (IME) Provider Exam Sites


Statewide Payee Registration and W-9 Form


Web pages For Medical Providers

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