Here is an impairment rating template compatible with the state’s rule set

Impairment Rating Template for State Specific Rule Set (Word file)

Administrative Rule Set

Indiana does not specify a rule set, though physicians often use the AMA Guides 5th Edition, or the AMA Guides 6th Edition

Physician’s Report

Here is a link to the form (opens pdf file)

Indiana State Form 2118 (R4 / 8-11)

Guide to Indiana Workers’ Compensation (2007)

Here is a link to the form (opens word document)

Labor Department

Here is a link to Workers’ Compensation Board