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§ 124. Specified Financial Interest Attachment to QME Forms 100, 103 or 104 (“SFI Form 124”).

8 CA ADC § 124Barclays Official California Code of Regulations

Barclays California Code of Regulations
Title 8. Industrial Relations
Division 1. Department of Industrial Relations
Chapter 1. Division of Workers' Compensation -- Qualified Medical Evaluator Regulations
Article 10.5. QME Process Forms
8 CCR § 124
§ 124. Specified Financial Interest Attachment to QME Forms 100, 103 or 104 (“SFI Form 124”).
Currentness
Any physician who files a QME Form 100 (Application for Appointment), 103 (QME Fee Assessment Form) or 104 (Reappointment Application) with the Administrative Director also shall complete the QME SFI Form 124, in order to disclose specified financial interests that may affect the fairness of QME panels, and append it to the form 100, 103 or 104 being submitted when the form is filed.
Image 1 within § 124. Specified Financial Interest Attachment to QME Forms 100, 103 or 104 (“SFI Form 124”).​
NOTE: Form is available at no charge by downloading from the web at www.dir.ca.gov/dwc/forms.html or by requesting at 1-800-794-6900.

Credits

Note: Authority cited: Sections 53, 133, 139.2 and 5307.3, Labor Code. Reference: Section 139.2, Labor Code.
History
1. New section filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).
This database is current through 5/10/24 Register 2024, No. 19.
Cal. Admin. Code tit. 8, § 124, 8 CA ADC § 124
End of Document