Washington State Department of Labor and Industries Forms

This form is used for requesting travel reimbursement in Washington for Somali individuals.

This form is used for requesting travel reimbursement in Washington for Tagalog speakers.

This document is used for requesting travel and wage reimbursement for an Independent Medical Exam (IME) in Washington, specifically in Albanian language.

This form is used for requesting travel and wage reimbursement for an Independent Medical Exam (IME) in Washington state. It is specifically designed for individuals who speak Chuukese.

This form is used for requesting travel and wage reimbursement for Independent Medical Exams (IMEs) in Washington state. It is available in French.

This form is used for requesting travel and wage reimbursement related to an Independent Medical Exam (IME) in Washington state. This particular version of the form is available in Croatian.

This form is used for requesting reimbursement for travel and wages related to an Independent Medical Exam in Washington, specifically for Marshallese individuals.

This Form is used for requesting travel and wage reimbursement for an Independent Medical Exam in Washington for Polish speakers.

This form is used for requesting travel and wage reimbursement related to an Independent Medical Exam (IME) in Washington for Hmong-speaking individuals.

This form is used for requesting travel and wage reimbursement for an Independent Medical Exam (IME) in the state of Washington for Samoan individuals.

This form is used for requesting travel and wage reimbursement for an Independent Medical Exam (IME) in Washington, specifically for Tagalog speakers.

This Form is used for submitting provider credentials for interpretive services in Washington.

This form is used for requesting travel and wage reimbursement for an Independent Medical Exam (IME) in Washington.

This form is used for faxing the Independent Medical Examination report in Washington.

This form is used for reporting when a person fails to show up for their scheduled independent medical exam or cancels it late in the state of Washington.

This form is used for Vietnamese-speaking residents in Washington to apply for job modification assistance.

This Form is used for creating an ownership agreement for tools and equipment used in vocational training plans in Washington.

This form is used for applying for job modification assistance in Washington for Korean speakers.

This form is used for reporting and assessing resource utilization group (RUG) residential care services provided to injured workers in Washington. It helps track and evaluate the level of care and resources needed for injured workers during their recovery process.

This Form is used for requesting authorization for preferred drug prescriptions in Washington state.

This document is used to apply for job modification assistance in Washington. It is specifically for Russian speakers.

This form is used for requesting authorization for hearing aid repair or replacement through the Durable Medical Equipment Provider Hotline Service in Washington.

This form is used for the checklist of IME facilities in Washington. It ensures that the facilities meet the necessary requirements and standards.

This form is used for updating information about an approved IME Examiner in the state of Washington.

This Form is used for submitting a statement for Option 2 training in Washington.

This form is used for authorizing electronic billing in the state of Washington.

This Form is used for requesting reimbursement for home nursing services in the state of Washington.