Notice of Request for Follow-Up DIME Forms
| Form Name | Notice of Request for Follow-Up DIME |
| Form # | WC178 |
| Form Revision | Rev 07/25 |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Colorado |
| Language | English |
| State Description | This form must be submitted when the claimant previously had a Division IME and was determined to be 'not at MMI', and the insurer/respondent is now requesting a follow-up IME. It may also be used on |
| Claimwire Description | n/a |