Reasonableness of Fee Dispute Resolution Request
Document Number: WKC-9498
Description: This form should be used ONLY for fee disputes related to treatment provided on or after July 1, 1992.
Comments: This form is not fill-enabled. It can be printed and completed by hand.
Content Contact: Kathy Froehlich
Document Attachment: WKC-9498 (pdf/18 KB)
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