Get Interpretive Services Appointment Record

This guide will help you navigate the process of filling out the Interpretive Services Appointment Record online. By following these instructions, you can ensure that you complete the form accurately and efficiently, streamlining your document management needs.

Follow the steps to complete the form online effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated editing platform.
2. Fill in the worker information section. Enter the worker's name in the format of last name, first name, and middle initial. If necessary, provide the internal control number (ICN) you received for this appointment if you have billed the department using Direct Entry.
3. Provide the date of injury using the mm/dd/yy format.
4. In the Interpreter Information section, enter the interpreter’s name, provider number, agency’s name (if applicable), and agency’s group number.
5. Complete the Appointment Information section by specifying the type of appointment (e.g., diagnostic, vocational) and the appointment date in the mm/dd/yyyy format. Also, indicate the language requested and the name of the healthcare or vocational provider.
6. In the Billing Information section, answer whether this is a group service and if it is the first or last appointment of the day. State the number of people in the group if applicable and address any mileage-related details.
7. Fill in the necessary addresses for the starting point, appointment location, and return or next appointment address, including city, state, and zip code.
8. Record the arrival time, scheduled start time, actual start time, end time, and any associated mileage or billing details.
9. Sign and date the Interpreter's signature section, certifying that the information provided is accurate.
10. Complete the Interpreter Service Verification section by having the healthcare or vocational provider or their designee print their name, title, NPI or L&I provider number, signature, date, and phone number.
11. Finally, save your changes, download the completed form, and either print or share it as needed.

Complete your documents online now for an efficient and streamlined process.