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How to fill out the Dwc 10 Form online
This guide will help you navigate the process of completing the Dwc 10 Form online. By following the comprehensive steps outlined below, you will ensure that your form is filled out accurately and efficiently.
Follow the steps to complete the Dwc 10 Form with ease.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out Section 1, which requires the employee's name, social security number or division assigned number, date of accident, date of birth, gender, and the name and address of the insurer or carrier.
- If you are billing for prescription drugs, move to Section 2. Here, you will need to include specific details such as the NDC number in the prescribed format, quantity, days of supply, medication strength, and the prescriber's name along with their Florida Department of Health license number.
- For billing related to medical equipment and supplies, complete Section 3. This section asks for descriptions of the items, HCPCS codes, purchase or rental dates, quantities, usual charges, and the prescriber's information.
- Finally, in Section 4, enter the name and physical address of the pharmacy or medical supplier, the FEIN, remittance recipient's name, and the pharmacist's license number.
- After filling out all sections, review the information for accuracy and completeness. Once satisfied, you can save changes, download, print, or share the form as needed.
Complete your Dwc 10 Form online today for a smooth filing experience.
“For information about the workers' compensation claims process and your rights and obligations, go to .dwc.ca.gov or contact an Information and Assistance (I&A) officer of the state Division of Workers' Compensation. For recorded information and a list of offices, call toll-free 1-800-736-7401.”
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