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O. Box 71010 Oakland CA 94612 510 286-3700 or 800 794-6900 Fax 510 622-3467 QME APPOINTMENT NOTIFICATION FORM To the Qualified Medical Evaluator You are required by law to give notice on this form when an appointment has been made with you to perform a QME comprehensive medical evaluation. Please complete this form in its entirety. The Administrative Director also requires that you serve this appointment...
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