Washington Labor and Industries Prosthetic Device Request Form is a document used by prosthetics and orthotics to apply for coverage of prosthetic devices from the Washington Department of Labor and Industries (L&I). There are two types of this form: 1) the Prosthetic Device Request Form (DR) and 2) the Orthotic Device Request Form (ODR). The DR is used to request coverage for prosthetic devices such as lower and upper limb prostheses, spinal outhouses, and custom cranial outhouses. The ODR is used to request coverage for orthotic devices such as ankle-foot outhouses, knee-ankle-foot outhouses, and cervical collars. Both forms must be completed and signed by the prosthetic or orthotic, the physician, and the patient or the patient’s representative. The form must also include the patient’s diagnosis, the medical necessity for the device, and the type of device requested.
Washington Labor and Industries Prosthetic Device Request Form
Description
How to fill out Washington Labor And Industries Prosthetic Device Request Form?
Handling legal documentation requires attention, precision, and using properly-drafted templates. US Legal Forms has been helping people countrywide do just that for 25 years, so when you pick your Washington Labor and Industries Prosthetic Device Request Form template from our library, you can be certain it complies with federal and state regulations.
Working with our service is simple and fast. To get the required paperwork, all you’ll need is an account with a valid subscription. Here’s a brief guide for you to obtain your Washington Labor and Industries Prosthetic Device Request Form within minutes:
- Make sure to carefully check the form content and its correspondence with general and law requirements by previewing it or reading its description.
- Search for an alternative official blank if the previously opened one doesn’t match your situation or state regulations (the tab for that is on the top page corner).
- ​Log in to your account and save the Washington Labor and Industries Prosthetic Device Request Form in the format you need. If it’s your first time with our service, click Buy now to proceed.
- Create an account, choose your subscription plan, and pay with your credit card or PayPal account.
- Choose in what format you want to save your form and click Download. Print the blank or upload it to a professional PDF editor to prepare it paper-free.
All documents are drafted for multi-usage, like the Washington Labor and Industries Prosthetic Device Request Form you see on this page. If you need them in the future, you can fill them out without re-payment - just open the My Forms tab in your profile and complete your document any time you need it. Try US Legal Forms and accomplish your business and personal paperwork quickly and in total legal compliance!