Colorado Level II accredited physicians use Figure 84 to bring a spine rating together. For each region it records impairment from specific disorders (Table 53 or 54), range of motion, neurologic loss of sensation or strength and other findings, combines them into regional and total spine impairment, then combines the spine with other organ system impairments into a whole person rating.
The Level II accredited physician performing the rating, either the authorized treating physician or a Division IME physician, completes it. The injured worker completes nothing.
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Spine Impairment Summary Worksheet (Figure 84)
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Only when the patient qualifies for an impairment under Table 53, the specific disorders table. The worksheet notes this on the range of motion line. Motion itself is measured and recorded on Figures 81 to 83 for the cervical, thoracic and lumbar regions.
The Division posts two versions: the standard spine impairment summary and a Figure 84 with apportionment. When apportioning a prior spinal impairment, raters also use Desk Aid 10 for previous ROM impairment and Desk Aid 14, the apportionment calculation worksheet.
A Level II accredited physician performing the permanent impairment rating, using the AMA Guides, Third Edition (Revised), as Rule 12 requires. The worksheet is reproduced with the American Medical Association's permission.