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Get NY IME-3 2014-2024

SE TO REQUEST REGARDING INDEPENDENT MEDICAL EXAMINATION 1. INDEPENDENT EXAMINER'S NAME AND ADDRESS 2. NAME AND ADDRESS OF PARTY REQUESTING INFORMATION 3. INDEPENDENT EXAMINER'S IME AUTHORIZATION NO. 4. IME ENTITY REGISTRATION NO. (If Applicable) 5. DATE OF INDEPENDENT MEDICAL EXAMINATION 6. CLAIMANT'S NAME 7. CLAIMANT'S WCB CASE NO. 8. DATE OF INJURY 9. DATE OF THIS REPORT Pursuant to Section 137 of the Workers' Compensation Law (WCL), if an independent examiner who has performed or will.

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