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: Maralyn Lytle
- 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.
WC Medical Regulations Officer