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COLORADO DEPARTMENT OF LABOR & EMPLOYMENT DIVISION OF WORKERS' COMPENSATION Clear Entire Form APPLICATION FOR 24 MONTH DIVISION INDEPENDENT MEDICAL EXAMINATION (IME) REQUESTED PURSUANT TO C.R.S. 8-42-107(8)(b)(II)(A)-(D)

How to fill out division independent medical examination

How to fill out division independent medical examination:

1. Start by carefully reading all the instructions provided with the division independent medical examination form. It is important to understand the purpose and requirements of the examination.
2. Provide personal information accurately. This includes your full name, contact information, date of birth, and any other identification details requested on the form.
3. Fill out the date and time of the examination. Ensure that you schedule the examination at a convenient time for you.
4. Answer all the medical history questions honestly and thoroughly. It is crucial to provide accurate information about any previous medical conditions, treatments, or injuries.
5. Give a detailed account of the reason for the examination. Explain any specific incidents or situations that led to the need for the examination, if applicable.
6. If there are any accompanying documents or reports related to your medical condition, ensure that they are properly attached or enclosed with the examination form.
7. If the form requires the signature of a healthcare professional, make sure to schedule an appointment and obtain the necessary signatures.
8. Review the completed form carefully to verify that all the required fields have been filled out accurately and completely. Make any necessary corrections or additions before submitting the form.

Who needs division independent medical examination?

1. Individuals involved in legal cases where their medical condition is relevant to the proceedings may require a division independent medical examination. This examination provides an unbiased evaluation of their medical condition.
2. Insurance companies may require division independent medical examinations to assess the extent of injuries, disabilities, or illnesses claimed by policyholders for proper claim processing.
3. Employers may request division independent medical examinations when determining the fitness of an employee to perform specific job duties or when evaluating work-related injuries.
4. Division independent medical examinations may be required for individuals seeking disability benefits from government agencies or private organizations.
5. Certain government agencies may require division independent medical examinations for licensing or certification purposes in specific professions.

Note: It is important to consult with relevant authorities or legal professionals to determine whether a division independent medical examination is necessary in your specific situation. The requirements and procedures may vary based on jurisdiction and circumstances.

For pdfFiller’s FAQs

What is division independent medical examination?

Division independent medical examination is a medical evaluation conducted by a neutral medical professional to assess an individual’s injuries or medical condition in relation to a legal case or claim.

Who is required to file division independent medical examination?

Both plaintiffs and defendants in a legal case or claim may be required to file a division independent medical examination.

How to fill out division independent medical examination?

Division independent medical examination forms must be completed by a designated medical professional who will conduct the evaluation.

What is the purpose of division independent medical examination?

The purpose of division independent medical examination is to provide an objective evaluation of an individual’s injuries or medical condition for use in legal proceedings.

What information must be reported on division independent medical examination?

Division independent medical examination must include detailed medical history, physical examination findings, diagnostic test results, and treatment recommendations.

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