Department of labor medical authorization

    • [DOC File]Labor and Industries

      https://info.5y1.org/department-of-labor-medical-authorization_1_fe3c54.html

      Concurrent Care (authorization required) Transfer of Care Consultation. Closing Exam and Impairment Rating This form is an optional communication tool. Attending Provider: Do not request referral or consultation if IME has been ordered. Obtain CM authorization for …

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    • [DOC File]Form 106 - Kentucky Labor Cabinet

      https://info.5y1.org/department-of-labor-medical-authorization_1_6d7225.html

      This authorization shall remain valid for 180 days following its execution. A photocopy of the authorization may be accepted in lieu of the original. The authorization includes, but is not restricted to, a right to review and obtain all copies of all records, x-rays, x-ray reports, medical charts, prescriptions, diagnoses, opinions and courses ...

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    • [DOC File]Self-Insurance Provider's Initial Report

      https://info.5y1.org/department-of-labor-medical-authorization_1_5d41ab.html

      medical release authorization: pursuant to rcw 51.36.060, i hereby authorize my health care provider, hospital, agency or organization to disclose to my employer or my employer’s representative or the department of labor & industries any relevant medical records or other information regarding treatment which has previously been furnished to me.

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    • [DOC File]State of Connecticut Department of Labor

      https://info.5y1.org/department-of-labor-medical-authorization_1_e85884.html

      A general authorization for the release of medical or other information is . NOT. sufficient for this purpose. This release expires on ____/____/_____. If no date is indicated, this release expires six months from date below. ... State of Connecticut Department of Labor ...

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    • [DOC File]DOL FORM 7 - Vermont

      https://info.5y1.org/department-of-labor-medical-authorization_1_7e6d39.html

      Department of Labor Workers’ Compensation Division PO Box 488. Montpelier, VT 05601-0488 (802) 828-2286. State File No.: Ins. Co. File No.: VERMONT WORKERS’ COMPENSATION MEDICAL AUTHORIZATION. NOTE: Title 21 VSA §655a requires all providers to utilize and comply with this medical release.

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    • [DOC File]OWCP MEDICAL FEE SCHEDULE - 2001 - U.S. Department of …

      https://info.5y1.org/department-of-labor-medical-authorization_1_d54535.html

      All Medical Authorizations are now handled by our private contractor, ACS. The voice phone number for medical authorizations is (866) 335-8319, Monday-Friday, 8:00AM – 8:00PM EST. Providers may fax medical authorization requests to (800) 215-4901. Please be sure to put the claimant case number on each page you fax.

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