Independent Medical Examination (IME) Provider Exam Sites
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| 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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