PDF
Word
QME Form 111 Qualified Medical Evaluator's Findings Summary Form - Unrepresented Injured Employee Cases Only - California
What Is QME Form 111?
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 the QME Form 111?
A: The QME Form 111 is a Qualified Medical Evaluator's Findings Summary Form.
Q: When is the QME Form 111 used?
A: The QME Form 111 is used only for unrepresented injured employee cases in California.
Q: What does the QME Form 111 summarize?
A: The QME Form 111 summarizes the findings of a Qualified Medical Evaluator.
Q: Who fills out the QME Form 111?
A: The Qualified Medical Evaluator fills out the QME Form 111.
Q: What is the purpose of the QME Form 111?
A: The QME Form 111 is used to provide a summary of the evaluation findings for unrepresented injured employees.
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 111 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 111 Qualified Medical Evaluator's Findings Summary Form - Unrepresented Injured Employee Cases Only - California
1
2
3
4
