Use the links below to access Employer Medical Assistance (EMA) forms. The forms below can be submitted online or downloaded as indicated below.
Printable forms should be filled out and faxed to 206-320-2655. The EMA Work Injury Emergeny Room Referral form is not available for online submission. It should be printed, filled out, and taken with you to a Swedish Emergency Room.
For more information or questions, please contact Laura Walden at laura.walden@swedish.org or 206-781-6008.
EMA Client Enrollment
or download and fax a printable form.
EMA Client Service Request and Treatment Authorization
download and fax a printable form.
EMA Work Injury Emergency Room Referral
Download the printable form. You must take this filled out form with you when you visit the Swedish Emergency Room.
EMA Client Feedback
or download and fax a printable form.
Contact Information
Employer Medical Assistance (EMA) Program
5300 Tallman Ave NWBallard Campus
Seattle, WA 98107-3985
Phone: 206-781-6008
Fax: 206-320-2655
Email: EMA@swedish.org
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