Medical Forms Order Form
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Medical Forms Order Form. This is a Oregon form and can be use in Medical Workers Comp.
Loading PDF...
Tags: Medical Forms Order Form, 3210, Oregon Workers Comp, Medical
Oregon John A. Kitzhaber, MD, Governor Department of Consumer and Business Services Workers' Compensation Division 350 Winter St. NE PO Box 14480 Salem, OR 97309-0405 1-800-452-0288, 503-947-7810 www.wcd.oregon.gov WORKERS' COMPENSATION MEDICAL FORMS ORDER FORM Your name: Company name: Address: Phone: ( ) Quantity Form title Worker's and Health Care Provider's Report for Workers' Compensation Claim *Reporte del Trabajador y del Proveedor Médico para Reclamaciones de Compensación para Trabajadores (827s) (Spanish) **Request for Administrative Review of Medical Issues (Bulletin 293) Form # 440-827 440-827s 440-2842 *Limited quantities are available for shipment. **One copy will be shipped. Please duplicate as needed. These forms are also available on our website: www.wcd.oregon.gov Please mail or fax this order form to: Workers' Compensation Division Operations Section Publications 350 Winter St. NE P.O. Box 14480 Salem, OR 97309-0405 440-3210 (3/11/WCD/WEB) American LegalNet, Inc. www.FormsWorkFlow.com Phone: 503-947-7627 Fax: 503-947-7630
