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Independent Medical Exam Comments F245-053-000 - Washington

Independent Medical Exam Comments Form. This is a Washington form and can be used in Independent Medical Exam (IME) Workers Comp .
 Fillable pdf Last Modified 12/29/2005
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Independent Medical Exam Comments Provider Quality & Compliance PO Box 44322 Olympia WA 98504-4322 Please use the space below to give us your comments, positive or negative, about your recent IME. Date of Exam IME Company Name (if known) Name of Doctor (if known) Name of Doctor (if known) Claim Number Comments Please be specific: Signature Date American LegalNet, Inc. www.FormsWorkFlow.com F245-053-000 Independent Medical Exam Comments 02-2017
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