How to use or fill out independent examiner medical examination form with our platform
- Click ‘Get Form’ to open the independent examiner medical examination form in the editor.
- Begin by filling out the 'CHECK ONE' section, selecting either PHYSICIAN, PODIATRIST, CHIROPRACTOR, or PSYCHOLOGIST based on your qualifications.
- Enter the WCB Case Number and Carrier Case Number if known. Fill in the injured person's first name, middle initial, last name, and Social Security Number.
- Provide details such as the date of injury/illness, date of examination, and address of the injured person. Ensure all information is accurate for proper processing.
- Document the start time and end time of the patient examination along with total time spent reviewing records.
- If applicable, state the name and Workers' Compensation Board registration number of your IME company.
- Attach any required reports or questionnaires as specified in the instructions before certifying your report at the end of the document.
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