PDF
Word
QME Form 121 Declaration Regarding Protection of Mental Health Record - California
What Is QME Form 121?
This is a legal form that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is QME Form 121?
A: QME Form 121 is a declaration regarding the protection of mental health records in California.
Q: What is the purpose of QME Form 121?
A: The purpose of QME Form 121 is to safeguard the confidentiality of mental health records.
Q: Who needs to fill out QME Form 121?
A: QME Form 121 needs to be completed by qualified medical evaluators (QMEs) in California.
Q: What does QME Form 121 require?
A: QME Form 121 requires QMEs to declare that they have protected the confidentiality of mental health records.
Q: Are mental health records protected under QME Form 121?
A: Yes, QME Form 121 ensures the protection and confidentiality of mental health records.
Form Details:
- Released on February 1, 2009;
- The latest edition provided by the California Department of Industrial Relations - Division of Workers' Compensation;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of QME Form 121 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.
Download QME Form 121 Declaration Regarding Protection of Mental Health Record - California
1
2
