RateFast Overview – California Permanent and Stationary (PR-4) Impairment Reports

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The below video illustrates how to use RateFast to write a PR-4 report.

For more detailed instructions on using RateFast to write PR-4 reports, check out this blog post on How to create PR-4 reports in RateFast.

What is a PR-4 Permanent & Stationary Report? (for patients)

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What is a PR-4 report? What is a permanent and stationary report?

The significance of a PR-4 report can be confusing to patients. This video below explains the significance of PR-4 reports for injured workers. This video introduces the topic of PR-4 reports. I’ve shown it to a few of my patients before the actual PR-4 examination takes place. It answers about 80% of the common questions that patients have about the report and the exam—a real time saver for everybody.

If you’re a patient and you have a work injury, then this video will cast some light on how your work injury is going to be evaluated and rated.

If you’re a medical provider or office manager at a medical clinic, please feel free to use the video to help explain the significance of the permanent and stationary report to injured workers that you are going to examine. Send your patients the link to this post via email, and they can watch it on their home computer—or on their cell phones while they’re in the waiting room.

Do you have all the tools you need to perform an impairment exam?

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Doctors can’t calculate an accurate impairment rating without the proper tools. Here at RateFast, we’ve reviewed a lot (a lot) of impairment ratings, and in our experience, one reason why doctors produce incorrect unjustifiable ratings is because they did not take the necessary measurements.

Accurate impairment ratings require accurate measurements, and to get the right measurements, you need the right tools.

Tools to Calculate Impairment Ratings

  1. Height and weight scale and blood pressure cuff — You need basic measurements and the worker’s basic vital signs.
  2. Tape measure — Made of flexible material, like fabric.
  3. Goniometer — Used for measuring joint ranges of motion. We prefer using goniometer apps on our phones. If you have an Android phone, you can download the RateFast Simple Goniometer for free from the Google Play store. If you have an iPhone, check the Apple App Store soon!
  4. Inclinometer — An inclinometer is used to measure the spine ranges of motion. You can also use use two phone goniometers, or one digital master/slave inclinometer.
  5. Grip dynomometer — Here in California, this is only for pain-free cases, greater than one year from date of injury or surgery.
  6. Pinch dynomometer — Like the grip dynomometer, this is only for pain-free cases, greater than one year from date of injury or surgery.
  7. Monofilament set — Be sure to have a 10 gram member in the set.
  8. Two point nerve discriminator — You can use a bent paperclip measured to 6 mm distance.

That does it. Once you get these tools, you’ll be ready to gather the correct measurements for your impairment ratings like a pro.

What about the rating itself?

Of course, to actually calculate the impairment rating in California (and many other states), you’ll also need the A.M.A. Guides 5th Edition. Then, you’ll need some time to plow through all the tables, diagrams, and charts.

Alternatively, you can join RateFast, and let our impairment rating specialists calculate the rating for you.

Functional Limitations Explained

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There’s a lot of confusion and misconception about the terms of use of “work tolerance”, “work capacity” and “work restrictions”.  When we read impairment reports “work restrictions” tend to be the term utilized most frequently. Actually, the exact opposite is true.

We’re here to help set the record straight on definitions.

A Physician’s Guide to Return to Work (Talmage et al., 2005. A Physician’s Guide to Return to Work. AMA Press) offers useful definitions for these terms  to better describe and communicate these concepts.

Work tolerance is the most common of all work limitations encountered. Tolerance simply means the patient’s symptoms preclude them from participating in certain activities. For example, the employee may have a normal MRI of the shoulder, a normal range of shoulder motion on exam, yet pain symptoms preclude work at or above shoulder level height.

Work capacity is the second  most common of all work limitations encountered. Work capacity refers to a well defined underling medical condition which precludes the patient from performing an activity. In this example a patient with shoulder adhesive capsulitis may demonstrate specific findings on MRI and the condition may also be verified on physical exam testing. For example, the patient may have mechanical limitation preventing motion of the shoulder above 90 degrees. In this situation patient has a medical capacity which limits working at or above shoulder level height.

Work restrictions are the least common of all work limitations encountered. Work restrictions are activities the patient can do, but should not perform because of the risk of significant injury or loss of life. For example,  the patient who has a seizure disorder may have a restriction precluding the driving of a car, because of the possibility of losing control of the vehicle.

We understand that the term “work restriction” has become a cultural term used in many administrative forms, however, inappropriate usage causes unnecessary confusion and delay. Begin using the correct terminology for tolerance, capacity and  restriction to more effective communication in reports and correspondence. Your reward will be faster and more accurate results.