Get Me M-1

Filling out the ME M-1 form is a crucial step in the workers' compensation process. This guide provides a clear, step-by-step approach to help users complete the form effectively online, ensuring that all necessary information is accurately recorded.

Follow the steps to successfully complete the ME M-1 form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the employer name and mailing address at the top of the form. Ensure accuracy, as this information will be used throughout the claim process.
3. Fill in the insurer name and mailing address, including details for any third-party administrator if applicable.
4. If known, include the claim number to help track the case effectively.
5. Provide the employee's name along with the last four digits of their Social Security Number and date of birth.
6. Indicate the date of injury and select the type of examination being reported (initial, progress, or final) by checking the appropriate box.
7. Describe the patient’s complaints succinctly to ensure clarity.
8. Record the diagnosis and indicate if it is work-related by checking the correct box. If diagnostic tests have been performed, list them under the appropriate section.
9. Outline the treatment plan, checking all applicable options, and note if the treatment includes any medications affecting the patient's ability to drive or work safely.
10. Assess the patient’s work capacity, marking whether they can return to their regular duty, require modified work, or have no work capacity, with additional details where necessary.
11. List any body parts affected by the injury and assess the permanent impairment rating if applicable.
12. Lastly, ensure the form is signed by the healthcare provider, including their printed name, address, and telephone number.
13. Once completed, save your changes and prepare to download, print, or share the form as needed.

Complete your ME M-1 form online today to ensure a smooth claims process.