Instructions for completion of the UB-04 (DFS-F5-DWC-90-D)

Department of Financial Services

This government document is issued by Department of Financial Services for use in Florida

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File Details: PDF
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https://www.myfloridacfo.com/division/wc/pdf/Form%20DFS-F5-DWC-90-D%20Instructions%20Rev%2012.08.15.pdf
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  • Workers' Comp Medical Reimbursement And Utilization Review
  • Workers' Comp Medical Reimbursement And Utilization Review

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