Get Form 83d20, Worksafebc. Request For Authorization For Orthotic Services

Filling out Form 83D20 is a crucial step in obtaining authorization for orthotic services through WorkSafeBC. This guide provides step-by-step instructions to help users complete the form accurately and efficiently, ensuring a smoother process.

Follow the steps to successfully complete the request for authorization.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of request in the ‘Date of request’ field using the format yyyy-mm-dd.
3. Fill out the worker information section, including the last name, first name, middle initial, mailing address, WorkSafeBC claim number, personal health number, and birthdate.
4. In the service information section, provide details regarding the referring physician if applicable. Additionally, indicate the area and type of injury, current device, years of current device, and recommended device, including justification for any repair, replacement, or change.
5. Complete the fields for quantity, fee code, description (including serial number if applicable), unit cost, and total amount in the service information section.
6. In the provider information section, include the name of the orthotist/pedorthist, their signature, name of the clinic, clinic mailing address or stamp, clinic payee number, clinic telephone number, and clinic fax number.
7. In the WorkSafeBC authorization section, enter the name of the WorkSafeBC officer, their signature, and the date of authorization.
8. If applicable, use the additional comment section to note any further information required.
9. Review the completed form for accuracy and clarity, ensuring all required fields are filled out correctly.
10. Save your changes, and choose to download, print, or share the form as necessary.

Complete your documents online now to facilitate your request for orthotic services.