Personal Injury Office (PI Office)

PI products to assist your practice:

1. PI Files & Forms is a CD with many word processing files including forms, letters, worksheets, examination forms, logs, report examples etc. These files are designed for fast modifications in your office. Quickly add your practice logo, address, add or delete or change &/or alter the forms to fit your needs. No longer do you need to have a physical Master Forms File/Notebooks or a drawer full of forms. All PI forms on the computer will have your practice information and print clean, looking great.

Doctor and staff responses to PI Files & Forms are overwhelmingly positive. The Utah Edition contains Utah Relative Value Fee Schedules published by the Utah Insurance Commission, and many Utah Labor Commission forms.

2. Motor Vehicle Collision Occupant Injury References – This is a large volume of data (56 pages and more than 300 references by topic) that may be use for a multitude of purposes. (Including coping/pasting into your reports/settlement brochures or creating your own macros)

Index of References:
• PI Report Writing Macros (32 pages nearly 100 reference footnoted)
• Malingering BM Waddell (10 pages more than 17 references)
• Motor Vehicle Collision Occupant Injury (MVCOI) Acute CAD Risk Factors
• (11 pages 94 references)
• MVCOI Chronic CAD Risk Factor (7 pages 42 references)
• MVCOI General Topic (28 pages more than 151 references)

3. States PI Reference Digital Book – With this you can modify, customize and print.
• Charts and information that are critical to have immediately on hand for patient/client education and report writing/references. Feel free to add to or customize this section to your needs.

4. Healthcare Report of Finding Digital Book – With this you can modify, customize and print.
• This flip chart type presentation for new patient and re-examination report of findings. Because this information is on CD you can customize or change to fit your practice needs. Both healthcare and PI (Croft Guidelines) are available for your patients.

Disability Forms:

AMA Impairment Pain Eval T 18-4
Cornell Men’s
Cornell Women’s
General Disability Quest
General Pain Disability Index
Impact of Events Scales (2) (New)
Neck Disability Index Questionnaire Scoring
Neck Disability Index
Revised Oswestry

Roland Morris Acute LBPExamination Forms:

Cervical RoM – Grip/Pinch Strength Worksheet
Cervical Range of Motion Age/Sex Matched Graph
Exam Room Charts
Examination Form 8 pages
Grip Strength Loss Formula
Hoppenfeld 5 Cs Test Principles
Motion in the CS Penning
RE-exam protocol

Traumatic Brain Injuries Sx List (Updated) General Forms & Information:

Abbreviations Key
Employee Application
Fibromyalgia Summary Sheet
Job Evaluation Form
Super Bill
X-ray Prescription Form (Updated)
Pain Scale Faces (Updated)
Pain Assessment Tools/Pics/Languages (13) (New)

VAS Multi Faceted Symptom Evaluation

Initial Paperwork:

Application for Treatment (Updated)
Assignment of Benefits (Updated)
Assignment of Benefits Alternative (New)
Authorization for Absence
Fee Slip Back Side (New)
Fee Slip Front Side (New)
Fee Slip Front Side Alternative language
Head Injury Questionnaire
Medical HX 1-3 (Updated)
In House Prescription
Lien (Updated)
OPPQRST 3 pages (Updated)
Patient Intake Form (New)
Release of Med records

Travel Card 2 sidesLegal Forms:

Affidavit
Assignment of Settlement and Recovered Proceeds*
At Fault Carrier Lien*
Authorization To Release Medical Records And Information (For Attorneys)
Authorization for Medical Records Release
Authorization and Assignment*
Auto-Health Conflict Ltr
Confidential Records Form
Consent to Eval & Rx a Minor
Cover Letter to At Fault Insurance Co*
Deposition Letter
Firm PI Client Instructions Utah (New)
Health Ins Agreement
Informed Consent (New)
Insurance Codes Utah (Partial)
Investigation Notice to Staff
Lien
Notary Public Certification
Promissory Note
Release of Information and Statutory Lien for Insurance Carrier*
Satisfaction of Judgment Form
Settlement Agreement
Trial Fee Conformation Letter
Trial Fee Conformation Letter Option 2
Trial Financial Letter to Patients Attorney option 2
Trial Financial Letter to Patients Attorney
Utah Practice Act (Law) (Updated)

Waiver of the Privilege of Confidentiality between Physician and PatientLetters:

Attending Physicians Report Response (Updated)
CROM GST Explanation Letter
DME Physiatrist response (Updated)
Medical Disability Advisor Rebuttal Ltr (New)
No Record of Patient (Updated)
Pronex Denial Response Letter (Updated)
Pronex Cervical Distraction Device (Updated)
Referral Letter to Specialist

Release over 60 days old response (New)Logs:

Job Task
Insurance Verification
Patient Call Log
Patient PI Class Sign up
Radiographic Log
Records Log
Referral Log

 

Miscellaneous:

Appointment Book Form (New)
Checks Payable & Mass. Cancel Policy/Sign (New)
Common PI CPT Codes
Common MVCOI ICD-9 Dx & Codes (New)
Copied Records Warning (New)
Credit Card Pre Arrangement (New)
Fax Cover Sheet (New)
IME DME Preparation Article (New)
IME/DME Strategies (New)
IME/DME Visit Form
Independent Contractor Agreement (New)
Mileage Log (New)
Vision Statement (New)

Office Closed Signs:

New Years
Human Rights Day/Martin Luther King Day (New)
Easter
Independence Day
Pioneer Day
Labor Day
Happy Halloween
Thanksgiving

Christmas Patient Information:

Cell Phones Off Sign
Cervical Pillow Article
Cervical Pillow Instructions
Ice Therapy Instructions
Ice & Heat Instructions
Ice & Cervical Pillow Inst combined (New)
New Patient Info Instructions
TMD Instructions

Report – Worksheets:

Attorney Cover Letter (New)
Croft Guidelines
Final Report Example 1 (New)
Final Report Example 2 (New)
Final Report Worksheet (Updated)
Initial Report Example 1 (New)
Initial Report Example 2 (New)
Initial Report Worksheet (Updated)
Update Interim Report (New)

Work Sheets:

Malingering Worksheet
Occupant Positioning
Tx Rules & CAD Protocol for ROF
X-ray Worksheet (Updated)

Waddell Worksheet (New)Other Files:

Booking Personal Injury Training Seminar Form
Ordering Personal Injury Products Form

Free Ware Logos/Graphics:

Back.jpg
Balanced Man.jpg
Spine Logo.jpg

Whiplash.jpg Tax Forms:

W-9

Utah Edition Includes:

Utah Labor Commission:

2006 Utah Impairment Guides.pdf
2006 Utah Impairment Guides FORMS.pdf
Form 102 Change of Physicians
Form 110 Return to Work
Form 112
Form 123
Form 123 Addendum
Form 123 Master
Form 221 with Instructions
Form 223
WC Agreement to pay regardless

WC Cover letter Utah Automobile Relative Value Schedules:

1998
2000
2003
2005 (New Medical & Dental) (New)
Common UT PI CPT Codes 2001
Common UT PI CPT Codes 2003
Common UT PI CPT Codes 2005 (New)

 

Personal Injury Office (PI Office).