Health Care Providers Independent Medical Examinations

Health Care Provider

• Initial Application for Health Care Providers and Independent Medical Examiners
• Authorization Renewal for Health Care Providers and Independent Medical Examiners

IME forms

• IME-3 - Practitioner's Report of Request for Info./Response to Request re IMEPDF
• IME-4 - Practitioner's Report of Independent Medical ExaminationPDF
• IME-5 - Claimant's Notice of Independent Medical ExaminationPDF
• IME-7 - Statement of Registration for entities deriving income from independent medical examinationsPDF
• Implementation of Forms Associated with SLU Evaluations

IME entities

• IME Entities Currently RegisteredPDF
• IME Entities Removed (During last 3 years)PDF