Wyoming Workers' Compensation asks treating chiropractors to document re-examinations of injured workers in active care on this one-page form. The Division's chiropractic utilization guidelines call for a re-exam about every four weeks, and after any exacerbation, to show the care is producing progress. If the patient has already been discharged, the chiropractor enters the discharge date, signs and returns the form instead.
The treating doctor of chiropractic completes and signs the whole form: subjective complaints, daily-living limits, exacerbations, orthopedic and neurologic findings, range of motion, muscle strength, PDQ scores, assessment, plan and complicating factors. The patient and employer have no section.
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Chiropractic Patient Exam/Re-exam Form
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The Division's chiropractic utilization guidelines, effective January 1, 2025, expect a re-examination about every four weeks to show progressive benefit of care, plus a re-exam after any exacerbation. Monthly re-exam documentation is not required once a worker is in approved supportive care, which is considered only for workers with an ascertainable loss and an impairment rating of at least 5% WPI.
Yes, if they include every item the form asks for. The guidelines let computerized office notes substitute when titled 'Re-exam Notes,' with a legible signature, the claimant's name, claim number and date of birth, and the practice's name and contact information. Incomplete or illegible notes are not accepted.
Mark yes to the discharge question at the top, enter the discharge date, sign and fax the form back to the Division. Only patients still under active care need the full form, which also asks for the number of prior treatments before the ten exam sections.