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This version of the form is not currently in use and is provided for reference only. Download this version of
Form C-17 (BWC-1122)
for the current year.
Form C-17 (BWC-1122) Request for Injured Worker Outpatient Medication Reimbursement - Ohio
What Is Form C-17 (BWC-1122)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-17?A: Form C-17 is a document used in Ohio to request reimbursement for outpatient medication for injured workers.
Q: What is the full name of Form C-17?A: The full name of Form C-17 is Request for Injured Worker Outpatient Medication Reimbursement.
Q: Who can use Form C-17?A: Form C-17 can be used by injured workers in Ohio.
Q: What is the purpose of Form C-17?A: The purpose of Form C-17 is to request reimbursement for outpatient medication expenses incurred by injured workers.
Q: Is Form C-17 specific to Ohio?A: Yes, Form C-17 is specific to Ohio and used for requesting reimbursement in that state.
Form Details:
- Released on January 6, 2023;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form C-17 (BWC-1122) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
Download Form C-17 (BWC-1122) Request for Injured Worker Outpatient Medication Reimbursement - Ohio
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