Get the free QME Form 116 Notice of late QME/AME report - California ... - dir ca
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STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF WORKERS COMPENSATION MEDICAL UNIT P. O. Box 71010 Oakland, CA 94612 (510) 286-3700 or (800) 794-6900 Fax: (510) 622-3467 (date) NOTICE
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What is qme form 116 notice?
QME Form 116 notice is a form used in the California workers' compensation system to notify the parties involved of a Qualified Medical Evaluator (QME) panel request.
Who is required to file qme form 116 notice?
The requesting party, typically the injured worker, or their representative is required to file the QME Form 116 notice.
How to fill out qme form 116 notice?
To fill out QME Form 116 notice, you need to provide information such as the injured worker's name, contact information, date of injury, nature of injury, and the requesting party's details.
What is the purpose of qme form 116 notice?
The purpose of QME Form 116 notice is to initiate the process of obtaining a QME panel to evaluate the injured worker's medical condition and provide an impartial medical opinion.
What information must be reported on qme form 116 notice?
QME Form 116 notice requires reporting of the injured worker's name, contact information, date of injury, nature of injury, requesting party's details, and any relevant medical records or documentation.
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