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Form 221B Restorative Services Authorization / Denial - Upper Extremity - Utah
What Is Form 221B?
This is a legal form that was released by the Utah Labor Commission - a government authority operating within Utah. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 221B?
A: Form 221B is a document used for Restorative Services Authorization/Denial for Upper Extremity injuries.
Q: What does the form authorize/deny?
A: The form authorizes or denies restorative services for upper extremity injuries.
Q: Who uses Form 221B?
A: Form 221B is primarily used in Utah.
Q: What are restorative services?
A: Restorative services refer to medical procedures aimed at improving or restoring function to a body part, in this case, the upper extremity.
Q: What is an upper extremity?
A: The upper extremity includes the arm, forearm, wrist, and hand.
Q: What information is required on Form 221B?
A: Form 221B requires information about the patient, the injury, and the requested restorative services.
Form Details:
- Released on October 1, 2019;
- The latest edition provided by the Utah Labor Commission;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 221B by clicking the link below or browse more documents and templates provided by the Utah Labor Commission.
Download Form 221B Restorative Services Authorization / Denial - Upper Extremity - Utah
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