REQUEST FOR DISMISSAL OF APPLICATION FOR PAYMENT OF ADDITIONAL REIMBURSEMENT OF MEDICAL FEES Forms
| Form Name | REQUEST FOR DISMISSAL OF APPLICATION FOR PAYMENT OF ADDITIONAL REIMBURSEMENT OF MEDICAL FEES |
| Form # | WC-MD-05 |
| 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 payment of additional reimbursement of medical fees in a workers compensation medical fee dipsute. |
| Claimwire Description | n/a |