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Worker Supply and Services Claim (form 3A)

Use this form to request reimbursement for approved medical supplies and services.

Vocational rehabilitation expenses are now submitted using Form 3B – Voc Rehab Expense Reimbursement.

Related forms
Worker Prescription Claim (form 3)
Worker Supply and Services Claim - Voc Rehab Expense Reimbursement (form 3B)

Publication Date: Nov 2019 File type: PDF (239 KB) Asset type: Form Form: 3A