Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with State of California, Department of Industrial Relations, Division of Workers' Compensation - Medical Unit before sending sensitive documents. FaxFlow is not affiliated with this organization.
State of California, Department of Industrial Relations, Division of Workers' Compensation - Medical Unit fax number
(510) 622-3467
Division of Workers' Compensation - Medical Unit
Used for: QME Form 112 (QME/AME Report Time Frame Extension Request) submission to the DWC Medical Unit by fax
Fax destination details
- Department
- Division of Workers' Compensation - Medical Unit
- Purpose
- QME Form 112 (QME/AME Report Time Frame Extension Request) submission to the DWC Medical Unit by fax
- Form
- QME Form 112 — QME/AME Report Time Frame Extension Request
- Voice phone
- (510) 286-3700; 1-800-794-6900
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
File with the Division of Workers' Compensation Medical Unit at least 5 business days before the report due date; you may fax the completed form with proof of service to (510) 622-3467. For more information call (510) 286-3700 or 1-800-794-6900.
Official form instructions are published as a downloadable file on the organization's website.
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