Washington State Department of Labor and Industries Forms

This form is used for calculating and recording third-party recovery amounts in Washington state. It helps individuals or organizations track and document payments received from external sources related to a specific incident or claim.

This form is used for an Individual Retrospective Rating Plan Agreement in the state of Washington. It is a contract between an individual and an insurance company to determine the premium for workers' compensation coverage based on the individual's actual claims experience.

This Form is used for applying to be included on the list of eligible attorneys in Washington state.

This Form is used for applying for group retrospective rating in the state of Washington. Group retrospective rating allows employers to potentially receive discounts on their workers' compensation premiums based on their collective claims experience.

This Form is used for applying for limited elective coverage for licensed pony riders in Washington state.

This form is used for providers outside the United States who want to apply for a provider account in Washington. The form is in French.

This document is used for making changes to an individual vocational provider account in Washington state.

This document is an opioid treatment agreement form used in the state of Washington. It outlines the terms and conditions between a patient and their healthcare provider regarding the use of opioid medications for treatment.

This Form is used for submitting primary contact information for VRC (Volunteer Rainfall Collection) in Washington state.

This form is used for requesting authorization for the use of buprenorphine transdermal patches in the state of Washington.

This form is used for requesting chronic opioid medication in the state of Washington.

This form is used for requesting prior authorization to exceed the three-day limit of opioids for dental procedures in the state of Washington.

This Form is used for requesting subacute opioids in the state of Washington. It is a request form that must be filled out to obtain subacute opioids for medical purposes.

This form is used for obtaining prior authorization for direct-acting antiviral medication for the treatment of Hepatitis C in the state of Washington.

This form is used for authorizing the release of information in the state of Washington.

This form is used for requesting prior authorization for the medication Lyrica (Pregabalin) in the state of Washington.

This type of document is an Authorization to Release Information form specific to the state of Washington. It allows individuals to provide consent for their information to be shared with a third party.

This form is used to authorize the release of information in the state of Washington, specifically for speakers of the Ilocano language.

This form is used to authorize the release of information in Washington. It is available in French.

This Form is used for requesting authorization to release information in the state of Washington, particularly for the Hmong community.

This Form is used for authorizing the release of information in Washington for individuals who identify as Mien.

This form is used for authorizing the release of information in Washington state. It is available in Polish language.

This form is used for authorizing the release of information in Washington. It is written in Portuguese.

This form is used to give permission for the release of information in Washington, specifically for the Somali community.

This form is used for negative pressure wound therapy in the state of Washington.

This form is used for reporting information related to occupational hearing loss in the state of Washington.

This form is used for documenting an individual's employment history related to hearing loss in the state of Washington.