Aid Codes Master Chart (aid codes) - Medi-Cal

State of California Division of Workers' Compensation - Medical Unit Replacement Panel Request-8 Cal. Code of Regulations section 31.5 (Please print or type) Claim number (Required) Middle Employee last name (Required) Initial Employee first name (Required) 1. QME Name (Required) 2. QME Name 3. QME Name Reason for Replacement (Required) ................
................