N.H. Admin. Code § Ret 502.11

Current through Register No. 44, October 31, 2024

Section Ret 502.11 - Filing of the Independent Examiner's Statement

(a) In all cases of disability retirement, the independent medical examiner shall evaluate the member's medical condition and file the evaluation form with the system.

(b) The independent medical examiner shall complete the medical evaluation form by providing the following:

(1) The examiner's name, specialty, board certification, mailing address and telephone number;

(2) A check in the appropriate boxes to indicate:

a.The type of disability; and

b.The type of case review or evaluation;

(3) An indication of the type of medical service that is being requested; and

(4) A written narrative which contain the diagnosis, treatment history and prognosis.

(c) The examiner shall complete the certification section by:

(1) Dating it;

(2) Checking the appropriate boxes to indicate:

a.Incapacity from duty;

b.Permanent incapacity; and

c.Its causal relationship to the members employment; and

(3) Signing it.

N.H. Admin. Code § Ret 502.11

#7574, eff 10-10-01, EXPIRED: 10-10-09

New. #9563, eff 10-14-09