Primary Treating Physicians Permanent And Stationary Report (2005 Permanent Disability Rating Schedule) {DWC-PR-4}

PR-4 - PRIMARY TREATING PHYSICIAN'S PERMANENT AND STATIONARY REPORT. This form is required to be used for ratings prepared pursuant to the 2005 Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment (5th Ed.). It is designed to be used by the primary treating physician to report the initial evaluation of permanent disability to the claims administrator. It should be completed if the patient has residual effects from the injury or may require future medical care. In such cases, it should be completed once the patient's condition becomes permanent and stationary. This form should not be used by a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) to report a medical-legal evaluation. www.FormsWorkflow.com