New Hampshire Code of Administrative Rules
Ret - Board of Trustees of the N.H. Retirement System
Chapter Ret 500 - FILING OF FORMS
Part Ret 502 - FORMS AND FILING REQUIREMENTS
Section Ret 502.11 - Filing of the Independent Examiner's Statement
Universal Citation: NH Admin Rules Ret 502.11
Current through Register No. 12, March 21, 2024
(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.
#7574, eff 10-10-01, EXPIRED: 10-10-09
New. #9563, eff 10-14-09
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