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

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

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

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.