Independent Medical Exam Comments (Spanish) Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Independent Medical Exam Comments (Spanish) Form. This is a Washington form and can be use in Independent Medical Exam (IME) Workers Comp.
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Tags: Independent Medical Exam Comments (Spanish), F245-053-999, Washington Workers Comp, Independent Medical Exam (IME)
Department of Labor and Industries COMENTARIOS SOBRE Provider Review & Education Unit PO Box 44322 Olympia WA 98504-4322 EL EXMEN MDICO INDEPENDENTE Por favor use este cuadro para darnos sus comentarios, positivos o negativos, acerca de su Exmen Mdico Independiente. Gracias. o mclaRero de eFecha del Exmen: Nm ) e (si lo sabmen el Exrealize a quNombre de la Compa Nombre del Doctor(es) (si lo sabe) (1) (2) Comentarios: (por favor sea especfico) Fecha Firma American LegalNet, Inc. F245-053-999 IME comments - Spanish 12-04 www.USCourtForms.com