Prince Edward Island Canada Workers Compensation Appeal Tribunal
Appointed Representative Form. Web appointment of representative name of party medicare number (beneficiary as party) or national provider identifier (provider or supplier as party) section 1: Web form approved omb no.
Prince Edward Island Canada Workers Compensation Appeal Tribunal
Web appointment of representative name of party medicare number (beneficiary as party) or national provider identifier (provider or supplier as party) section 1: You can use our electronic version of the form by asking your. If you are using this form to appoint a representative, you must complete sections 1, 2, and 3. Appointment of representative to be completed by the. Web contact your local hearing office and request an invitation to enroll. Web form approved omb no. Your representative must complete sections 5 and 7 of this form.
Appointment of representative to be completed by the. You can use our electronic version of the form by asking your. Web form approved omb no. Web contact your local hearing office and request an invitation to enroll. If you are using this form to appoint a representative, you must complete sections 1, 2, and 3. Web appointment of representative name of party medicare number (beneficiary as party) or national provider identifier (provider or supplier as party) section 1: Your representative must complete sections 5 and 7 of this form. Appointment of representative to be completed by the.
