California reappointment compensation 2026

1. Click ‘Get Form’ to open the California Reappointment Compensation form in the editor.
2. Begin with Section 1, where you must complete your personal information. Ensure that you type or print legibly your last name, first name, middle initial, suffix, contact address, business phone number, and email address. Don’t forget to include your California Professional License Number and its expiration date.
3. Move on to Section 2 if you are an M.D. or D.O. Here, indicate which requirements you meet for QME status by checking the appropriate boxes and providing any necessary documentation.
4. In Section 3, affirm your qualifications by selecting one of the listed criteria regarding your practice time or experience as an Agreed Medical Evaluator.
5. Proceed to Section 4 to specify the specialties for which you are applying. Use the enclosed specialty codes provided in the document.
6. Complete Section 5 by initialing each affirmation statement regarding your license status and any convictions. Attach explanations if necessary.
7. Finally, list any continuing education courses completed in Section 6 and ensure all information is accurate before signing at the bottom of the form.

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