Occupational or Physical Therapy Treatment Authorization Fax Request

Occupational or Physical Therapy Treatment Authorization Fax Request - (Forms/Publications)
Document Information
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Title Occupational or Physical Therapy Treatment Authorization Fax Request (A fillable form - 120 KB PDF)
Description

Used by a therapy provider/clinic to request authorization for outpatient occupational or physical therapy services for L&I claims.

Detail
Form number F248-055-000
Availability
Online only. See document above to download.
Keywords injured worker, occupational therapy, physical therapy, Provider Hotline, therapist
Languages English
Valid dates 08-2012
Contact information Managing Injured Workers' Claims
Web pages For Medical Providers

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