The Independent Medical Review Form is currently available in an Adobe PDF file for downloading and printing. To return the form, you may:
- Scan and return by e-mail to: Celeste Ackerman
- Fax the form to: Employment Relations Division, ATTN: Celeste Ackerman, 406-444-4140
- Mail the form to: Employment Relations Division, ATTN: Celeste Ackerman, PO Box 8011, Helena, MT 59604
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.
Workers' Compensation Medical Regulations Officer