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California Qualified Or Agreed Medical Evaluator Findings Summary Form

State:
California
Control #:
CA-QME-111
Format:
PDF
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Description

Qualified Or Agreed Medical Evaluator Findings Summary Form The California Qualified Or Agreed Medical Evaluator Findings Summary Form is a document used by a qualified medical evaluator or agreed medical evaluator (ME/AME) to record the findings of a medical evaluation. The form can be used to document the medical history, physical examination, diagnosis, and other relevant medical information about a patient for the purpose of evaluating the extent of a work-related injury or illness. This form is typically used in workers' compensation cases. There are two types of California Qualified Or Agreed Medical Evaluator Findings Summary Form: the DWC Form-113 and the DWC Form-115. The DWC Form-113 is a single-page summary of a medical evaluation, while the DWC Form-115 is a comprehensive multi-page summary of a medical evaluation. Both forms are used to provide detailed information on a patient's medical history, physical examination, diagnosis, and other medical findings to facilitate the determination of the extent of a work-related injury or illness.

The California Qualified Or Agreed Medical Evaluator Findings Summary Form is a document used by a qualified medical evaluator or agreed medical evaluator (ME/AME) to record the findings of a medical evaluation. The form can be used to document the medical history, physical examination, diagnosis, and other relevant medical information about a patient for the purpose of evaluating the extent of a work-related injury or illness. This form is typically used in workers' compensation cases. There are two types of California Qualified Or Agreed Medical Evaluator Findings Summary Form: the DWC Form-113 and the DWC Form-115. The DWC Form-113 is a single-page summary of a medical evaluation, while the DWC Form-115 is a comprehensive multi-page summary of a medical evaluation. Both forms are used to provide detailed information on a patient's medical history, physical examination, diagnosis, and other medical findings to facilitate the determination of the extent of a work-related injury or illness.

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California Qualified Or Agreed Medical Evaluator Findings Summary Form