Cal. Code Regs. tit. 8 § 124

Current through Register 2024 Notice Reg. No. 44, November 1, 2024

Section 124 - Specified Financial Interest Attachment to QME Forms 100, 103 or 104 ("Sfi Form 124")

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.

Click here to view image

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.

Cal. Code Regs. Tit. 8, § 124

1. New section filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).

Note: Authority cited: Sections 53, 133, 139.2 and 5307.3, Labor Code. Reference: Section 139.2, Labor Code.

1. New section filed 1-13-2009; operative 2-17-2009 (Register 2009, No. 3).