Request for Appointment to the Division Independent Medical Examination Panel (DIME) Forms
| Form Name | Request for Appointment to the Division Independent Medical Examination Panel (DIME) |
| Form # | WC076 |
| Form Revision | Rev 12/18 |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Colorado |
| Language | English |
| State Description | This form is used by a physician to apply for appointment as a Division Independent Medical Examiner. |
| Claimwire Description | n/a |