QME Services

Welcome to our Injured Worker QME Resource Center. At this location you will find the required forms necessary to begin your QME evaluation process.

If you need to schedule a QME appointment, please click here We ask in advance, that you print, read and complete each of these documents below prior to your scheduled evaluation. These forms, completed in advance, will insure that you have a timely visit, and your information is correct.

1) Find your rating clinic locations and print a map prior to your appointment. Please familiarize yourself with our locations in advance. Give yourself plenty of time to allow for traffic and driving in an unfamiliar location. Please arrive thirty minutes in advance of your scheduled appointment.

2) Fill out the required form for you QME examination: DEU 100. This form is required by the California Division of Workers Compensation to explain how you were injured, and how your injury presently affects your life and work. Download DEU 100

3) Fill out the required form for your QME examination: Injured Worker Comprehensive History Questionnaire: This form is a specially designed questionnaire to help the evaluating doctor learn more about you and your injury. Download the Comprehensive Injured Worker Questionnaire Learn More About the QME Process Still not finding what you need? Contact us at info@johnalchemymd.com.  


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