1149 Market Street Tacoma WA 98402 Ph 855 594 1351 Fax 253 552 5631 Email wwcohe chifranciscan org Website www CHIfranciscan orgCOHE Statement of ID: 818722
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COHE Administration ▪ 1149 Market S
COHE Administration ▪ 1149 Market Street ▪ Tacoma ▪ WA ▪ 98402 ▪ Ph. 855-594-1351 ▪ Fax: 253-552-5631 Email: wwcohe@chifranciscan.org | Website: www.CHIfranciscan.org/COHE Statement of Interest The Center of Occupational Health & Education (COHE) Program is a partnership between the Department of Labor & Industries (L&I), medical, and community resources, aimed at improving injured worker health outcomes. The COHE is dedicated to expanding community expertise in both occupational health care and disability prevention. The COHE Alliance of Western Washington is focused on improving care outcomes for injured workers in 19 Western Washington counties. The COHE is sponsored by CHI Franciscan Health and Franciscan Medical Group. Health care coordination is an important COHE service that assists providers, employees, and employers, as well as providing claim-specific services for coordinating care and addressing recovery challenges. The COHE Health Services Coordinators are located in Tacoma, Burien, and Vancouver/Longview offices. Qualified Medical Providers practicing in the 19 designated counties are eligible to apply for participation. To be qualified, the provider must have an active L&I Provider Account Number in the respective facility(ies) and be enrolled in L&I Medical Provider Network. By submitting this Statement of Interest, the listed provider/organization is only expressing interest in participating in the COHE Alliance of Western Washington. This is not a commitment to participate, nor is it a guarantee that the provider/organization will be accepted into the COHE. The final application steps include (in sequential order): 1) approval for partnership by the Program Director; 2) an orientation/training session for applicant providers and suitable clinic/facility support staff; 3) signature and fax/email delivery to the COHE of the L&I Provider Account Application Supplement for Attending Providers. Signature (Date) Name Title Organization