Sixth Edition — Essential IME Forms and Templates

The template package consists of Examinee Forms (including a Welcome, “Information and Instructions About Your Examination” (informed consent), Medical Evaluation Questionnaire, Pain Drawing, Functional Inventories (Pain Disability Questionnaire, QuickDASH, and AAOS Lower Limb Outcome Scale), and Satisfaction Survey (completed by the examinee at the end of the visit). Report templates are provided for females and males.

Best practices are to complete as much of the Template prior to the evaluation, including deleting sections that are not relevant. The resulting draft is used during the visit to record your findings and serves as the basis for your report. You may choose to dictate the examinee’s history in the presence of the examinee. You may complete your report using the draft document with notes; you will make edits and add text (which may be transcribed) as appropriate. When the report is complete, update the Table of Contents at the beginning of the report by moving your cursor over that section, right-clicking, and left-clicking on “Update Field.” Optionally, you may add an Index. Spell and grammar check prior to sending to your client.

Report formats are to be used and modified only by licensed purchasers. The licenses are for single users; multiple users may use them only if a written license permitting this is obtained from Brigham and Associates, Inc. Therefore, the templates are not to be shared in practice or among colleagues; such sharing lacks integrity, does not reflect an appreciation of the hundreds of hours involved in developing and refining these resources, and is illegal.

From and Template package includes:

  • Instructions on Use
  • Examinee Forms (PDF Version)
  • Examinee Forms (Word Version for editing)
  • Female Medical and Impairment Evaluation Report Template (Word Version for editing)
  • Male Medical and Impairment Evaluation Report Template (Word Version for editing)