Impairment Rating and Treatment Resources

Worksheets

• Apportionment
  • Apportionment of Impairment: Algorithm to determine if apportionment is appropriate
  • Apportionment Calculation Worksheet/Desk Aid 14: used to calculate an apportioned impairment rating
  • Evaluation of Previous Spinal ROM Impairment Worksheet/Desk Aid 10
  • Spine Impairment Summary Worksheet with Apportionment/Figure 84

• Hearing Impairment Rating Worksheet

• Lower Extremity Impairment Rating Worksheets
  • Lower Extremity Impairment Worksheet: Toes (optional use)
  • Lower Extremity Impairment Worksheet: Hip, knee, and ankle

• Mental Impairment Rating Worksheet
  • Guidelines for Assessing and Rating Areas of Function on the Mental Impairment Rating Worksheet

• Spine Impairment Rating Worksheets (used with permission from the AMA)
  • Cervical Range of Motion/Figure 81
  • Thoracic Range of Motion/Figure 82
  • Lumbar Range of Motion/Figure 83
  • Spine Impairment Summary Worksheet/Figure 84
  • Spine Impairment Summary Worksheet/Figure 84 - with apportionment

• Upper Extremity Impairment Rating Worksheets (used with permission from the AMA)
  • Upper Extremity Impairment Worksheet: Digits
  • Upper Extremity Impairment Worksheet: Shoulder, elbow, and wrist

• Vision Impairment Rating Worksheet

Resources

• QPOP Division-approved Test List
• Desk Aid 11 - Division's Impairment Rating Tips
• Impairment Rating Report Checklist With Submission Information
• Sample Impairment Rating Narrative Report: Sample of a sufficient narrative impairment rating report with essential elements
• Opioid Information
  • Important resources including patient agreements, risk assessment, mental health screening tools, functional assessments, and the Colorado Physician Drug Monitoring Program (PDMP). Chronic Opioid treatment information can be found in the chronic Pain Medical Treatment Guidelines.

                   View Opioid Information Here​

• Rules of Procedure
• Level I Accreditation Curriculum
• Level II Accreditation Curriculum
• Medical Treatment Guidelines: In-text references and bibliographies
• HIPAA Information/Release of Medical Record Information: By providers and payers
• Audio Recordings of IMEs: Answers to frequently asked questions regarding the audio recording of IMEs
• PEP Quick Guide for Occupational Exposures

Still have impairment rating questions? Please email Shannon Terrell, PT, DPT.

Rules

• Rule 12 - Impairment Rating Guidelines
• Rule 13 - Provider Accreditation