REQUEST FOR DISMISSAL OF APPLICATION FOR DIRECT PAYMENT Forms
| Form Name | REQUEST FOR DISMISSAL OF APPLICATION FOR DIRECT PAYMENT |
| Form # | WC-MD-10 |
| Form Revision | (01-23) |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Missouri |
| Language | English |
| State Description | A form for use by a health care provider requesting the dismissal of an application for direct payment in a workers compensation medical fee dispute. |
| Claimwire Description | n/a |