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Get QME Form 112 QME/AME Report Time Frame Extension Request - Dir Ca

RAME EXTENSION REQUEST (Send to DWC Medical Unit 5 or more days before report is due.) Request for 30 day extension Reason Lab or test results not received. Type of test: Report of consulting physician not received. Specialist type: Request for 15 day extension Reason Medical emergency of the evaluator or evaluator family member. Death in evaluator s family. Natural disaster/other community catastrophe interrupted office. Date Report will be served: Date of Phys.

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