Pharmaceutical Clinical Justification for Workers' Compensation Forms
| Form Name | Pharmaceutical Clinical Justification for Workers' Compensation |
| Form # | 440-4909 |
| Form Revision | 4/23 |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Oregon |
| Language | English |
| State Description | Medical service providers must complete this form when prescribing more than a five-day supply of certain high-cost drugs. |
| Claimwire Description | n/a |