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  • Washington Labor Forms
  • Wa F245-072-000 2014

Get Wa F245-072-000 2014-2025

Provider Signature I certify that the information in the bill is true and correct. I have not been reimbursed for any part of this bill. Signature Required for worker reimbursement Signature F245-072-000 Statement for Miscellaneous Services 01-2014 Date RESET Check the appropriate box for the type of service for which you are billing. STATEMENT FOR MISCELLANEOUS SERVICES Mail completed forms to Department of Labor and Industries PO Box 44269 Olym.

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How to fill out the WA F245-072-000 online

Filling out the WA F245-072-000 form online can streamline the process of billing for various services related to workers' compensation. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

  1. Click the ‘Get Form’ button to access the WA F245-072-000 form and open it in your browser's editor.
  2. In the 'Type of Service' section, check the appropriate box that corresponds to the service you are billing for. If your service is not listed, select 'Other' and specify the type.
  3. Complete the 'Worker Information' section by entering the required details: Claim Number, Name (Last, First, Middle Initial), Date of Injury, Home Address (not a PO Box), Social Security Number (for identification purposes only), and Phone Number.
  4. Fill in the 'Provider Information' section with the L&I provider number or NPI, provider name, provider address, your Patient Account Number (optional), Federal Tax ID, and the phone number for inquiry purposes.
  5. In the 'Billing Information' section, answer the questions about reimbursement to the injured worker and provide additional required information for inpatient services and prescriptions, if applicable.
  6. For each service rendered, use a separate line to detail: From date of service, To date of service, Place of Service (POS), Procedure Code, Modifier Codes (if applicable), Diagnosis, and a brief description of the services provided.
  7. Enter the number of hours billed or rates for services, along with the charges for each service and the total charge at the bottom.
  8. Sign and date the form where indicated. Ensure that both the worker and provider signatures are provided where necessary.
  9. After completing the form, save your changes, download a copy for your records, and if necessary, print or share the form as required.

Take action now and fill out the WA F245-072-000 online to ensure timely processing of your services.

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An L&I claim in Washington state works by providing financial assistance for workers injured on the job. After filing your claim, the Department of Labor & Industries reviews it, determining eligibility and benefits. Understanding the nuances of the process, including the use of forms like WA F245-072-000, can help ensure you navigate your claim effectively and receive the support you need.

To file a Washington L&I quarterly report, gather relevant payroll information and employee data for the reporting period. You can complete this report online by visiting the Washington State Department of Labor & Industries’ website. Incorporating the WA F245-072-000 helps maintain accuracy in your submission and ensures your company remains compliant with state regulations.

Claiming workers' compensation in Washington involves notifying your employer of your injury and filling out the necessary forms. You can do this through the Washington State Department of Labor & Industries' website. The WA F245-072-000 form is particularly useful to help you document your claim accurately and ensure you receive the benefits you deserve.

To file a L&I claim in Washington state, you need to gather necessary documents, including your employer's information and any medical reports. You will then complete the relevant forms, which can be found on the Washington State Department of Labor & Industries website. Consider using the WA F245-072-000 form to streamline your filing process. Submitting your application online can expedite the review of your claim.

For tourist inquiries, the state of Washington Tourism phone number is 1-800-544-1800. This number connects you to resources for exploring the state’s attractions, accommodations, and activities. Whether you have questions about specific locations or need help planning your trip, the staff can assist you. Don't forget to ask them how the WA F245-072-000 might relate to your travel documents.

Washington is often referred to by its state number, which is 42. This number represents Washington's admission to the United States as the 42nd state in 1889. Understanding this simple fact can enhance your appreciation for Washington's rich history. Additionally, if you are looking for legal forms or state documents, the WA F245-072-000 can guide you.

The number one attraction in Washington state is the iconic Space Needle, located in Seattle. This landmark offers breathtaking views of the city and surrounding mountains. Visitors can enjoy the observation deck, dining options, and various events year-round. If you plan on visiting, be sure to check local guidelines, like those related to the WA F245-072-000.

To file for WA L&I, you need to complete the necessary forms, which can be found on the L&I website. You may also submit your claim online through their portal for a more efficient process. Utilizing the WA F245-072-000 form correctly is crucial to ensure that your claim is processed smoothly.

The L&I injury payout in Washington state varies based on multiple factors including the nature of the injury and your wage at the time of the incident. Typically, the payout covers medical expenses and lost wages during recovery. Understanding the specifics of the WA F245-072-000 form can help you calculate your potential compensation more accurately.

The L&I law in Washington state encompasses regulations regarding workers' compensation, unemployment insurance, and workplace safety. It ensures that workers receive fair treatment and necessary benefits in case of job-related injuries or unemployment. Familiarizing yourself with the WA F245-072-000 can enhance your understanding of your rights under this law.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232