Get the free Request for Independent Medical Exam - Form 1015 - laworks

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1. Social Security No. 2. Date of Injury/Illness 3. Part(s) of Body Injured RETURN TO: OFFICE OF WORKERS' COMPENSATION POST OFFICE BOX 94040 BATON ROUGE, LA 70804-9040 (225) 342-7559 TOLL FREE (800)

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What is request for independent medical?

A request for independent medical is a formal document submitted to request an independent medical evaluation or examination.

Who is required to file request for independent medical?

The person or entity seeking an independent medical evaluation or examination is required to file the request for independent medical.

How to fill out request for independent medical?

The request for independent medical can typically be filled out by providing the necessary personal information, describing the reason for the request, and providing any relevant supporting documentation.

What is the purpose of request for independent medical?

The purpose of the request for independent medical is to obtain an impartial medical opinion or evaluation regarding an individual's health status or condition.

What information must be reported on request for independent medical?

The request for independent medical should include the individual's personal information, the reason for the request, any relevant medical history, and any supporting documentation or records.

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