Florida Regulations 69L-11.011

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§ 69L-11.011 Forms.

The following forms are incorporated by reference into this rule chapter.

(1) DFS Form |^DWC-23| ' Request for Screening, available from and shall be filed with, the district office of Rehabilitation and Medical Services.

(2) DFS Form PW-1 ' Identity Card, to be issued by the appropriate district office of Rehabilitation and Medical Services.

(3) DFS Form |^PW-2| ' Request for Reimbursement of Premium, available from, and shall be filed with: SDTF, Division of Workers' Compensation, 200 East Gaines Street, Tallahassee, FL 32399-4223.

Specific Authority 440.49, 440.591 FS. Law Implemented 440.49 FS. History-New 11-29-94, Formerly 38F-11.011, 4L-11.011.