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Get and Sign OTPT 4 6 04 WorkCompCentral 2004 Form

Get and Sign OTPT 4 6 04 WorkCompCentral 2004 Form

Use a OTPT 4 6 04 WorkCompCentral 2004 template to make your document workflow more streamlined.

NOTIFICACION O EN OTROS DOCUMENTOS RECIBIDOS POR USTED. IMPORTANTE PARA EL PACIENTE LAS FACTURAS POR SERVICIOS MEDICOS INCLUYENDO HOSPITALES Y TODO SERVICIO DE NATURALEZA MEDICA SERA PAGADO POR EL PATRONO O POR LA ENTIDAD RESPONSABLE O SU COMPANIA DE SEGUROS SEGUN SEA EL CASO SI SU RECLAMACION ES APROBADA. No. TELEPHONE NO. PATIENT S DATE OF BIRTH EMPLOYER INSURANCE CARRIER REFERRING PHYSICIAN/ PODIATRIST If treatment was under the VFBL or VAWBL show as Employer the liable political subdivision...
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