PLEASE PRINT OR TYPE SECTION 1. IDENTIFYING …
Signature of Carrier/Self Insured Employer or Utilization Review Company: Printed Name: The requested Treatment or Testing is approved The requested Treatment or Testing is denied because I hereby certify that this response of Carrier/Self Insured Employer for Authorization was (day) (month) (year) Emailed yy p py _____ day of , _____
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Unemployment Insurance Tax Guide for Employers
www.laworks.netUnemployment Insurance Tax Guide for Employers i Vision We will make Louisiana the best place in the country to get a job or grow a business, and our goal is to be
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