CLOSING COMMENTS SECTION:

The preceding overall assessment of Mr. Doe’s condition has been based upon the total of the data collected as part of the fact finding portion of this report.  Considerations for the complaints, as well as all examination, laboratory, diagnostic and/or radiographic analysis have been accounted for.  There remains prominent incidence of supporting evidence that such findings are highly consistent with the history of the injury, as experienced by this patient.

Mr. Doe has failed to reach complete restoration of his spinal injuries.  The erratic recurrence of symptomatology, along with positive objective findings on final discharge, show probable cause that later developments associated with an incomplete return to pre-injury status may yield premature accelerated developments of arthritis in the cervical spine, with subsequent narrowing of the intervertebral (nerve root) foramina and possible facet syndrome.

Unfortunately, despite repeated attempts with both chiropractic and allopathic medicine, and with all parties co-operating, Mr. Doe will regretfully be plagued with permanent losses to body parts/systems.  This has been expressed in the “Impairment Rating Section” of this report.  To aid in your understanding of the reduced functional capacities experienced by this patient in the accident, affidavits have been utilized.

To further explain the effect the injury has had on this individual’s life, affidavits have been employed as an accepted method of the Federal Social Security Administration’s method of representing the losses that occur to an individual’s activities of daily living.  This may be further referenced in the A.M.A. Guides.

To inform a patient that, despite attempted treatment, there are going to be residuals that will remain permanent, is one of the most difficult facts for a doctor to concede.  With this comes the doctor’s responsibility to honestly and accurately represent, not only the presence of impairments, but to ultimately conclude that this condition may have future ramifications other than bodily losses or reduced functional capabilities.  There may also be restrictions with regard to future employability or insurability.

Due to these factors, and to relieve myself of any disclosure liability, I have completely informed this patient of the medically rated permanencies and have received written acknowledgement of such fact.  Furthermore, I have acquired the permission of the patient to release, in narrative format, or otherwise, the results of the permanent medical impairment evaluation which was conducted in my office.

It has been suggested by the A.M.A., that in the presence of varying medical opinions, the evaluator who more closely utilizes the guides will be the evaluator who’s opinion will be more closely adhered to.

As felt, due to the traumatic injury suffered to the spine, the patient is prohibited from heavy lifting and walking for long periods of time.  The patient has been medically, adequately advised that there is a great potential for exacerbation and aggravation of this apparently stationary state, with a high incidence for the possibility of aggravation, as well as residual effects other than her present symptomatology.

 The degree of medical impairment is not likely to change by more than plus or minus 3% within the next year.
 

Throughout this report I have referenced the appropriate tables and chapters of the AMA Guides.  This was done in order to represent true medically rated losses to bodily functions, as they have been established by the AMA, and to show that the strict use of their methodologies and criteria has been employed in this evaluation.

It can be seen by virtue of the above mentioned examination procedures and shown according to the AMA referenced validity of assessment criteria, protocol and grading schemes, that Mr. Doe suffers from a 27% Whole Person Impairment.
 

Please refer to the “Glossary of Terms” as provided as an exhibit at the end of this report, for clarification of medical terms and qualifiers, especially as they may apply to descriptions regarding intensity, duration and frequency of signs and symptoms.

I hope this AMA Report of Medical Evaluation (Permanent Medical Impairment) and narrative report are sufficiently representative of the true medically rated losses as suffered by this patient.  If I can be of additional assistance in this matter, please do not hesitate to notify this office.

Enclosed you will find an itemized statement for services rendered with regard to this patient.

Sincerely,

C.M.Wilkerson, D.C.