Get the free QME Notice of Unavailability QME form 109 - State of California - dir ca
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State of California Division of Workers Compensation Medical Unit P.O. Box 71010 Oakland, CA 94612 Print Form Reset Form ME Notice of Unavailability Form must be filed 30 days prior to date of unavailability
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What is qme notice of unavailability?
The QME Notice of Unavailability is a form that is filed by a Qualified Medical Evaluator (QME) to inform the parties involved in a workers' compensation case that the QME is not available to perform an evaluation.
Who is required to file qme notice of unavailability?
The Qualified Medical Evaluator (QME) is required to file the QME Notice of Unavailability form if they are unable to perform an evaluation as scheduled.
How to fill out qme notice of unavailability?
To fill out the QME Notice of Unavailability form, the QME needs to provide their contact information, the case information, the reason for unavailability, and any proposed alternate dates for the evaluation.
What is the purpose of qme notice of unavailability?
The purpose of the QME Notice of Unavailability is to notify the parties involved in a workers' compensation case that the scheduled evaluation cannot be performed as planned and to propose alternate dates for the evaluation.
What information must be reported on qme notice of unavailability?
The QME must report their contact information, the case information, the reason for unavailability, and any proposed alternate dates for the evaluation on the QME Notice of Unavailability form.
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