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Wyoming Form Center -

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injrpt.pdf First Report of Injury
info.pdf A Guide to Workers Compensation in Wyoming
Wyoming_Workers_Compensation_Act.pdf POSTER - Wyoming Workers' Compensation Act
EmployersGuidePamphlet.pdf BROCHURE - Employer's Guide to Reporting an Employee Injury
InjuredWorkersGuidePamphlet.pdf BROCHURE - Injured Worker's Guide to Reporting an Injury
reimb.pdf Reimbursement Voucher
WCD9.pdf Employee's Application for Temporary Total Disability Benefits
APPREC-EXT.pdf Employee's Application for Temporary Total Disability (TTD) Benefits: Extraordinary Circumstances (24 36 Months)
changeaddress.pdf Change of Address or Change of Name
HCPCHG.pdf Request for Change of Health Care Provider
ROI.pdf Release of Information
DTHAPP.pdf Application for Death Benefits or Balance of Award
liteduty.pdf Agreement for Temporary Light Duty / Restricted Work
vendorpacket.pdf Vendor Management Packet
w9.pdf Irs Form W-9
vmfinstructions.pdf Vendor Management Form Instruction Sheet and Example
6n.pdf Claim for Non-Medical Services
10.pdf Claim for Pharmacy/Medical Supplies
NursingServices_ver3.pdf Claim for Home Nursing Services
initial_rpt.pdf Health Care Provider Initial Medical Report
chiroform.pdf Chiropractic Exam / Re-exam Form
Preauthorization.pdf Provider Request for Preauthorization Review
hippaletter.pdf HIPPA Letter
drugfreeworkplace.pdf Brochure: Drug Free Workplace