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Are there any abnormal physical or psychological examination findings 16. Are impairments described and measured using the AMA Guides QME Form 111 rev. Mar. 2007 17. STATE OF CALIFORNIA Division of Workers Compensation Medical Unit P. O. Box 71010 Oakland CA 94612 510 286-3700 or 800 794-6900 QUALIFIED OR AGREED MEDICAL EVALUATOR S FINDINGS SUMMARY FORM EMPLOYEE 1.
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qme form 111
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