Voluntary Directive For Alternative Service Of Medical Evaluation Report On Disputed Injury {QME 120}

QME Form 120 - VOLUNTARY DIRECTIVE FOR ALTERNATE SERVICE OF MEDICAL-LEGAL EVALUATION REPORT ON DISPUTED INJURY TO PSYCHE (Unrepresented Employees Only). This form is a California workers’ compensation form issued by the Division of Workers’ Compensation (DWC) Medical Unit. This form is used only by unrepresented injured employees in cases involving a disputed psychiatric injury. It allows the employee to voluntarily direct how they receive a copy of the Qualified Medical Evaluator (QME) medical-legal report. The employee may choose to have the report sent directly to them or sent first to a designated physician who will review the report with the employee during an office visit. The completed form must be attached to the original QME report and distributed to all required parties. www.FormsWorkflow.com