Common use of The IME Report Clause in Contracts

The IME Report. Upon completion of the IME, the Contractor must deliver the Physician’s comprehensive typed narrative report of his/her findings to OSC within 21 days of the date of the IME. The Report must be signed by the Physician and must include the following: (1) Complete identification of the Member, including name, age, gender, home address, System identification number and date(s) of injury (if applicable). NYSLRS requests, whenever possible, that a photocopy of a photo I.D. card (e.g., driver’s license), or a digital photo be attached to the Report as the last page. (Whether the Member is willing or declines to provide his/her picture, the examination should still take place. NYSLRS does not require a picture be provided as a condition of performing the examination. The picture is used to confirm that the person being examined is the same person as the Member appearing at hearings.) (2) Name of examining Physician and his/her specialty. (3) Summary of all records provided by OSC and/or provided by the Member. (4) Medical history of the Member including: • History of accident/injury and any intervening history. • If re-examination, intervening history. • History of any prior conditions which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and medical comorbidities/complicating factors. • Correspondence reviewed by examining Physician (must indicate all correspondence reviewed by the Physician for the examination). (5) Scope of examination and findings, including copies of medical test results and reports, including: • Description of examination, including any review of tests performed (if applicable). • Copies of the test results performed by the Physician or at the Physician’s request. • Discussion of issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency. • Conclusion, containing answers to the questions asked by the System. Physician should stay within his/her specialty and only respond to issues requested for review. (6) Testimony availability • Physicians must be available to provide testimony at OSC hearings. A Physician’s availability for testimony at hearings must be indicated on the Physician’s report and whether availability differs depending on the hearing location (availability includes “day of the week” and “A.M. and/or P.M.”). (7) Where applicable and appropriate, any safe and reasonable treatment options available.

The IME Report. Upon completion of the IME, the Contractor must deliver the Physician’s comprehensive typed narrative report IME Report of his/her their findings to OSC within 21 30 days of the date of the IME. The IME Report must be signed by the Physician and must include the followingfollowing information: (1) Complete identification of the Member, including name, age, gender, home address, System NYSLRS identification number and date(s) of injury (if applicable). NYSLRS requests, whenever possible, that a photocopy of a photo I.D. card (e.g., driver’s license), or a digital photo be attached to the IME Report as the last page. (Whether The IME should still take place even if the Member is willing or declines to provide his/her their picture, the examination should still take place. NYSLRS does not require a picture be provided as a condition of performing the examination. The picture is used to confirm that the person being examined is the same person as the Member appearing at hearings.) (2) Name of examining Physician and his/her their specialty. (3) Summary of all records provided by OSC XXXXXX and/or provided by the Member. (4) Medical history of the Member including: • History of accident/injury and any intervening history. , • If re-examination, intervening history. , • History of any prior conditions which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and medical comorbidities/complicating factors. , and • Correspondence reviewed by examining Physician (must indicate all correspondence reviewed by the Physician for the examination). (5) Scope of examination and findings, including copies of medical test results and reports, including: • Description of examination, including any review of tests performed (if applicable). , • Copies of the any test results performed by the Physician or at the Physician’s request. , • Discussion of issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency. , and • ConclusionThe Physician’s conclusion, containing answers to the questions asked by the SystemNYSLRS. The Physician should stay within his/her their specialty and only respond to issues requested for review. (6) Testimony availability • The Physicians must be available to provide testimony at OSC NYSLRS hearings. A Physician’s availability for testimony at hearings must be indicated on the Physician’s report and whether availability differs depending on the hearing location IME Report (availability includes “day of the week” and “A.M. and/or P.M.”). (7) Where applicable and appropriatePer NYSLRS’s request, any response(s) to issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment options availableof disability, maximum medical improvement, ability to return to work, and/or permanency.

The IME Report. Upon completion of the IME, the Contractor must deliver the Physician’s comprehensive typed narrative report Report of his/her findings to OSC within 21 days of the date of the IME. The Report must be signed by the Physician and must include the following: (1) Complete identification of the Member, including name, age, gender, home address, System identification number and date(s) of injury (if applicable). NYSLRS requests, whenever possible, that a photocopy of a photo I.D. card (e.g., driver’s license), or a digital photo be attached to the Report as the last page. (Whether The IME should still take place even if the Member is willing or declines to provide his/her picture, the examination should still take place. NYSLRS does not require a picture be provided as a condition of performing the examination. The picture is used to confirm that the person being examined is the same person as the Member appearing at hearings.) (2) Name of examining Physician and his/her specialty. (3) Summary of all records provided by OSC and/or provided by the Member. (4) Medical history of the Member including: • History of accident/injury and any intervening history. • , If re-examination, intervening history. • , History of any prior conditions which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and medical comorbidities/complicating factors. • , and Correspondence reviewed by examining Physician (must indicate all correspondence reviewed by the Physician for the examination). (5) Scope of examination and findings, including copies of medical test results and reports, including: • Description of examination, including any review of tests performed (if applicable). • , Copies of the any test results performed by the Physician or at the Physician’s request. • , Discussion of issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency. • Conclusion, and The Physician’s conclusion, containing answers to the questions asked by the System. The Physician should stay within his/her specialty and only respond to issues requested for review. (6) Testimony availability • The Physicians must be available to provide testimony at OSC hearings. A Physician’s availability for testimony at hearings must be indicated on the Physician’s report and whether availability differs depending on the hearing location (availability includes “day of the week” and “A.M. and/or P.M.”). (7) Where applicable and appropriatePer OSC request, any response(s) to issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment options availableof disability, maximum medical improvement, ability to return to work, and/or permanency.

The IME Report. Upon completion of the IME, the a) The Contractor must shall deliver the Physician’s comprehensive typed narrative report of his/her findings IME Report to OSC NYSLRS via Biscom within 21 30 days of the date of following the IME. The IME Report must be signed by the Physician and must include the followingfollowing information: (1) Complete identification of the i. The Member, including ’s name, age, gender, home address, System NYSLRS identification number number, and date(s) dates of injury (if applicable). NYSLRS requests, whenever possible, that the Physician conducting the IME attach a photocopy or digital photo of a photo I.D. card (e.g., driver’s license), or a digital photo be attached ) belonging to the Member to the IME Report as the last page. (Whether The Physician must still conduct the IME if the Member is willing or declines to provide his/her picture, the examination should still take place. NYSLRS does not require a picture be provided as a condition of performing the examinationtheir I.D. ii. The picture is used to confirm that the person being examined is the same person as the Member appearing at hearings.) (2) Name of examining Physician Physician’s name and his/her their specialty. (3) iii. A copy of any new records provided by the Member to the Physician during the IME. iv. Summary of all records provided by OSC XXXXXX and/or provided by the Member. (4) v. Medical history of the Member including: • History of the relevant accident/injury and any intervening history. , • If re-examination, intervening history. history since the last IME, • History of any prior conditions conditions, which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and medical comorbidities/complicating factors, and vi. • Correspondence reviewed by examining Physician (must indicate all All correspondence reviewed by the Physician for the examination)Physician. (5) vii. Scope of examination and findings, including copies of medical test results and reports, including: • Description A description of the examination, including any review of tests performed (if applicable). , • Copies of the any test results performed by the Physician or at the Physician’s request. , • Discussion of issue(s) regarding: issues regarding causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency. , and • ConclusionThe Physician’s conclusion, containing answers to the questions asked by the SystemNYSLRS. The Physician should stay within his/her the Physician’s specialty and only respond to issues requested for review. (6) Testimony availability • Physicians must be available to provide testimony at OSC hearingsviii. A The Physician’s availability for testimony at hearings must be indicated on hearings. ix. Per NYSLRS’ request, the Physician’s report and whether availability differs depending on the hearing location (availability includes “day of the week” and “A.M. and/or P.M.”). (7) Where applicable and appropriateresponses to issues regarding causal relationship, any diagnosis, safe and reasonable treatment options availableof disability, maximum medical improvement, ability to return to work, and/or permanency.

The IME Report. Upon completion of the IME, the Contractor must The Physician shall deliver the Physician’s comprehensive typed narrative report of his/her findings their IME Report to OSC NYSLRS via Biscom within 21 30 days of the date of following the IME. The Report IME Reports must be signed by the Physician and must include the followingfollowing information: (1) Complete identification of the a. The Member, including ’s name, age, gender, home address, System NYSLRS identification number and date(s) and, dates of injury (if applicable). NYSLRS requests, whenever possible, that the Physician conducting the IME attach a photocopy or digital photo of a photo I.D. card (e.g., driver’s license), or a digital photo be attached belonging to the Member to the IME Report as the last page. (Whether The Physician must still conduct the IME if the Member is willing or declines to provide his/her picture, the examination should still take place. NYSLRS does not require a picture be their I.D. b. The Physician’s name and their specialty c. A copy of any new records provided as a condition of performing the examination. The picture is used to confirm that the person being examined is the same person as by the Member appearing at hearings.) (2) Name of examining to the Physician and his/her specialtyduring the IME. (3) d. Summary of all records provided by OSC XXXXXX and/or provided by the Member. (4) e. Medical history of the Member including: • History of the relevant accident/injury and any intervening history. , • If re-examination, intervening history. history since the last IME, • History of any prior conditions conditions, which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and medical comorbidities/complicating factors. , and • Correspondence reviewed by examining Physician (must indicate all All correspondence reviewed by the Physician for the examination)Physician. (5) f. Scope of examination and findings, including copies of medical test results and reports, including: • Description A description of the examination, including any review of tests performed (if applicable). , • Copies of the any test results performed by the Physician or at the Physician’s request. , • Discussion of issue(s) issues regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency. , and • ConclusionThe Physician’s conclusion, containing answers to the questions asked by the SystemNYSLRS. The Physician should stay within his/her the Physician’s specialty and only respond to issues requested for review. (6) Testimony availability • Physicians must be available to provide testimony at OSC hearings. A g. The Physician’s availability for testimony at hearings must be indicated on hearings. h. Per NYSLRS’ request, the Physician’s report and whether availability differs depending on the hearing location (availability includes “day of the week” and “A.M. and/or P.M.”). (7) Where applicable and appropriateresponses to issues regarding: causal relationship, any diagnosis, safe and reasonable treatment options availableof disability, maximum medical improvement, ability to return to work, and/or permanency.

The IME Report. Upon completion of the IME, the Contractor Physician must deliver the Physician’s a comprehensive typed narrative report of his/her findings to OSC within 21 days of the date of the IME. The Report Reports must be signed by the Physician and must include the following: (1) Complete identification of the Member, including name, age, gender, home address, System identification number and date(s) of injury (if applicable). NYSLRS requests, whenever possible, that a photocopy of a photo I.D. card (e.g., driver’s license), or a digital photo be attached to the Report as the last page. (Whether the Member is willing or declines to provide his/her picture, the examination should still take place. NYSLRS does not require a picture be provided as a condition of performing the examination. The picture is used to confirm that the person being examined is the same person as the Member appearing at hearings.) (2) Name of examining Physician and his/her specialty. (3) Summary of all records provided sent by OSC and/or provided by the Member. (4) Medical history of the Member including: • History of accident/injury and any intervening history. • If re-examination, intervening history. • History of any prior conditions conditions, which may include work injuries, off-the-job injuries, unrelated physical and mental conditions, and identification of medical comorbidities/complicating factors. • Correspondence reviewed by examining Physician (must indicate all correspondence reviewed by the Physician for the examination). (5) Scope of examination and findings, including copies of medical test results and reports, including: • Description of examination, including any review of tests performed (if applicable). • Copies of the test results performed by the Physician or at the Physician’s request. • Discussion of issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment of disability, maximum medical improvement, ability to return to work, and/or permanency. • Conclusion, containing answers to the questions asked by the System. Physician should stay within his/her specialty and only respond to issues requested for review. (6) Testimony availability • Physicians The Physician must be available to provide testimony at OSC hearings. A The Physician’s availability for testimony at hearings must be indicated on the Physician’s report Report and whether availability differs depending on the hearing location (availability includes “day of the week” and “A.M. and/or P.M.”). (7) Where applicable and appropriatePer OSC request, any response(s) to issue(s) regarding: causal relationship, diagnosis, safe and reasonable treatment options availableof disability, maximum medical improvement, ability to return to work, and/or permanency.