Nurse Practitioner's Statement of Authorization Forms
| Form Name | Nurse Practitioner's Statement of Authorization |
| Form # | 440-2882 |
| Form Revision | 3/18 |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Oregon |
| Language | English |
| State Description | Used by nurse practitioner's to certify to the director of the Department of Consumer & Business Services that they have reviewed and read certain informational material provided by the WC Division. |
| Claimwire Description | n/a |