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PRINT CLEAR State of California, Division of Workers Compensation REQUEST FOR QUALIFIED MEDICAL EVALUATOR PANEL (Unrepresented Employee) TO REQUEST A QUALIFIED MEDICAL EVALUATOR (ME) PANEL FOR AN
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Request for qualified medical is a form submitted to request approval for medical treatment from a qualified medical provider.
Both the patient and the healthcare provider are required to file a request for qualified medical.
The request for qualified medical must be filled out with information about the patient's medical condition, treatment needed, and healthcare provider details.
The purpose of request for qualified medical is to seek approval for medical treatment that is deemed necessary by a qualified medical provider.
The request for qualified medical must include the patient's personal information, medical history, treatment plan, and healthcare provider's credentials.
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