California primary treating physicians use PR-4 to report the initial evaluation of permanent disability once a patient is permanent and stationary, for ratings under the 2005 Permanent Disability Rating Schedule. It reports whole person impairment under the AMA Guides 5th edition with tables and pages, any pain add-on, apportionment, future medical treatment and a functional capacity assessment.
Only the primary treating physician completes and signs it; a QME or AME must not use it to report a medical-legal evaluation.
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Primary Treating Physician's Permanent and Stationary Report (PR-4)
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State the specific reasons you could not make the determination. Under Labor Code 4663(c), as reprinted on the form, the physician then consults other physicians or refers the employee to another authorized physician so the final apportionment determination can be made.
No. The form says the functional capacity assessment is prepared only to decide whether the claimant can return to the usual occupation and is not considered in the impairment rating. For injuries on or after January 1, 2013, DWC-AD 10133.36 must also be completed.
Only the primary treating physician. QMEs and AMEs report medical-legal evaluations differently. The PR-4 is completed when the patient has residual effects or may need future care, once the condition is permanent and stationary, and is signed with California license number and specialty.