The Independent Medical Review Request Form is currently available in an Adobe PDF file for downloading and printing. To return the form, you may:
Questions? E-mail Maralyn or call her at 406-444-6604
Download the form here:
ePass Montana is a convenient and secure way to send Medical Records with the Independent Medical Review Request.
Go to this link, https://app.mt.gov/epass/epass, to set up an ePass Montana account and bookmark it in your favorites. ePass Montana is for State of Montana Business only. Using the File Transfer Service, send all documents to the following email address: firstname.lastname@example.org