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State of California Division of Workers Compensation Medical Unit P. O. Box 71010 Oakland CA 94612 Print Form Reset Form QME Notice of Unavailability Form must be filed 30 days prior to date of unavailability QME first name Required Print or type QME last name Required Print or type Complete both pages of this application to request unavailability. It is not an acceptable reason to request unavailability that a QME does not intend to perform evaluations for unrepresented workers. A QME who is...
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What is qme notice of unavailability?
The QME Notice of Unavailability is a form that notifies the Division of Workers' Compensation (DWC) about the unavailability of a qualified medical evaluator (QME) to conduct a medical evaluation.
Who is required to file qme notice of unavailability?
Any QME who is unable to perform a scheduled medical evaluation is required to file the QME Notice of Unavailability.
How to fill out qme notice of unavailability?
To fill out the QME Notice of Unavailability, QMEs must provide necessary information such as their name, QME number, date of unavailability, reason for unavailability, and any prior notice given to the parties involved.
What is the purpose of qme notice of unavailability?
The purpose of the QME Notice of Unavailability is to inform the DWC and the involved parties about the unavailability of a QME to perform a scheduled medical evaluation.
What information must be reported on qme notice of unavailability?
The QME Notice of Unavailability should include the QME's name, QME number, date of unavailability, reason for unavailability, and any prior notice given to the parties involved.
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