Chapter 1. Industrial Medical Council
Article 10. QME Application Forms

§100. The Application for Appointment as Qualified Medical Evaluator Form.

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IMC FORM 100 (Rev. 7.01)

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IMC FORM 100 (Rev. 7.01)

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IMC FORM 100 (Rev. 7.01)

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IMC FORM 100 (Rev. 7.01)

For Use on the QME Reappointment Application Form
IMPORTANT: PLEASE USE THREE LETTER SPECIALTY CODE WHEN
COMPLETING BLOCK 8 OF APPLICATION FORM

 

	MD/DO Specialty Codes	Non-MD/DO Specialty Codes

MAI	Allergy and Immunology	*denotes a doctor of chiropractic
MAA	Anesthesiology	who has completed a chiropractic

MRS

Colon & Rectal Surgery

post-graduate specialty program

MDE

Dermatology

MEM

Emergency Medicine

ACA

Acupuncture

MFP

Family Practice - MD

DCH

Chiropractic

OFP

Family Practice - DO

DCN

Chiropractic-Neurology*

OFM

Family Practice - DO -

DCO

Chiropractic

Including Osteopathic

-Orthopaedic*

Manipulation

MPM

General Preventive Medicine

DCR

Chiropractic - Radiology*

MOH

Hand-Orthopaedic Surgery

DCS

Chiropractic - Sports

Medicine*

MPH

Hand-Plastic Surgery

DCT

Chiropractic -

Rehabilitiation*

MSH

Hand-Surgery

DEN

Dentistry

MMM

Internal Medicine

OPT

Optometry

MMV

Internal Medicine-

POD

Podiatry

Cardiovascular Disease

PSY

Psychology

MME

Internal Medicine-Endocrinology

PSN

Psychology-Clinical

Diabetes and Metabolism

Neuropsychology

MMG

Internal Medicine-

Gastroenterology

MMH

Internal Medicine-Hematology

MMI

Internal Medicine-Infectious

Disease

MMO

Internal Medicine-Medical Oncology

MMN

Internal Medicine-Nephrology

MMP

Internal Medicine-Pulmonary Disease

MMR

Internal Medicine-Rheumatology

MOQ

Medicine - Otherwise Qualified

MPB

Neurological Surgery-Including Back

MPN

Neurology

MNS

Neurological Surgery

MNM

Nuclear Medicine

MOG

Obstetrics and Gynecology

MPO

Occupational Medicine

MOP

Ophthalmology

MOS

Orthopaedic Surgery

MOB	Orthopaedic Surgery-
	Including Back
MTO	Otolaryngology
MAP	Pain Management-Anesthesiology
MPP	Pain Management-Pain Medicine
MHA	Pathology

		MD/DO Specialty Codes

MEP	Pediatrics
MPR	Physical Medicine & Rehabilitation
MPS	Plastic Surgery
MPD	Psychiatry
MRY	Radiology
MSY	Surgery
MSG	Surgery-General Vascular
MTS	Thoracic Surgery
MPT	Toxicology-Occupational Medicine
MET	Toxicology-Emergency Medicine
MUU	Urology

HISTORY


1. Renumbering of former article 10 to new article 15, new article 10 (sections 100-104) and new section filed 4-14-2000; operative 5-14-2000 (Register 2000, No. 15). For prior history see Register 94, No. 31.


2. Amendment filed 8-23-2001; operative 8-23-2001 pursuant to Government Code section 11343.4 (Register 2001, No. 34).

3. Change without regulatory effect amending section filed 5-2-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 18).