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Last updated: 10/24/2024
IME Provider Account Application {F245-046-000}
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Description
F245-046-000 - IME PROVIDER ACCOUNT APPLICATION NEW / ADD PAYEE. This form is used by healthcare providers to apply for approval as an Independent Medical Exam (IME) provider with the Washington State Department of Labor and Industries (L&I). It is required for providers who wish to perform IMEs for workers' compensation claims in Washington. The form gathers detailed information about the provider, including tax details, medical qualifications, practice information, and legal history. Providers must submit necessary supporting documents and agree to comply with state laws and regulations governing medical exams, billing, and patient care for injured workers. www.FormsWorkflow.com
