Independent Medical Examination (IME) Provider Exam Sites

Independent Medical Examination (IME) Provider Exam Sites - (Forms/Publications)
Document Information
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Title Independent Medical Examination (IME) Provider Exam Sites (A fillable form - 128 KB PDF)
Description

List the locations where the doctor does independent medical exams on a regular basis.

Detail
Form number F245-047-000
Availability
Online only. See document above to download.
Keywords application, doctor, exams, independent medical examiner, independent medical exams, medical, physician
Languages English
Valid dates 03-2007
Contact information Claims for Job Injuries
Treating Injured Workers
Related information
Documents

Provider Account Application - Independent Medical Examiner (IME)


Statewide Payee Registration and W-9 Form


Web pages For Medical Providers

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