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State of California Division of Workers Compensation-Medical Unit ME Appointment Notification Form To the Qualified Medical Evaluator: Please complete this form in its entirety. You are required by

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What is qme appointment notification form?

QME appointment notification form is a document used to inform the Division of Workers' Compensation (DWC) about the appointment of Qualified Medical Evaluators (QMEs) for workers' compensation cases.

Who is required to file qme appointment notification form?

The party responsible for obtaining the QME panel is required to file the QME appointment notification form. This can be the injured worker, the employer, or their respective representatives.

How to fill out qme appointment notification form?

To fill out the QME appointment notification form, you need to provide information such as the injured worker's name, claim number, date of injury, and contact information. You also need to specify the specialty of the QME being appointed and the desired appointment location.

What is the purpose of qme appointment notification form?

The purpose of the QME appointment notification form is to notify the DWC about the appointment of a QME for a workers' compensation case. This allows the DWC to track and monitor the QME appointment process.

What information must be reported on qme appointment notification form?

The QME appointment notification form must include information such as the injured worker's name, claim number, date of injury, contact information, specialty of the QME being appointed, and desired appointment location.

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