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Get Form 83D19, WorkSafeBC. Request For Authorization For Prosthetic Services

Er provided below. FAX 604 233-9777 Toll-free 1 888 922-8807 CLAIMS CALL CENTRE Phone 604 231-8888 Toll-free 1 888 967-5377 Date of request (yyyy-mm-dd) Worker information Worker last name First name Middle initial WorkSafeBC claim number Worker s mailing address Personal health number Worker s current occupation (if applicable) Birthdate (yyyy-mm-dd) Service information Level of amputation Left side Right side Current device description Primary r Back-up r Other r (plea.

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