Spine
Cervical, thoracic, lumbar. Posture, ROM, neuro screen, special tests.
Decision support. Smart exam templates, the MTUS / ACOEM alignment check, treatment-plan guardrails, and structured work restrictions are decision-support reference for the treating physician, who performs the exam, sets the plan and restrictions, and signs the chart. ChironAI does not make a regulatory clearance claim; see Disclosures.
ChironAI OMExam and plan
Exam and plan, reasoned against the regulatory chain.
The clinical half of every WC visit is the exam and the plan. The physician performs the exam; Chiron reasons the plan against it in body-region-specific templates that carry forward structured visit context and surface what changed since last time. Every proposed treatment is checked against MTUS (California) and ACOEM (national) at the point of care, not after the fact — every treatment plan is checked against MTUS and ACOEM before it is finalized, not after a UR denial teaches you the hard way.
Smart exam templates
By body region, with carry-forward.
Upper extremity
Shoulder, elbow, wrist, hand. Provocative tests by region.
Lower extremity
Hip, knee, ankle, foot. Gait, weight-bearing, joint-specific tests.
Head and neck
Cranial-nerve screen, neuro, neck ROM, occupational hearing/vision.
Chest and torso
Cardiopulmonary, abdominal, occupational chest exposures.
Mental health screen
PHQ-9, GAD-7, PTSD screen where occupationally relevant.
Structured visit context carries forward from the prior visit. Prior-value diff hints surface changes since last evaluation. The clinician’s time goes to clinical judgment, not retyping.
ChironAI™ OMLumbar re-check · carry-forward
Prior-value diff hints
Lumbar flexion (ROM)
40° (2026-05-18) 55°
Improved 15° since the prior visit — supports a functional-improvement note for continued PT authorization.
Straight-leg raise, right
Positive at 35° Positive at 50°
Threshold moved higher — worth confirming whether radicular symptoms have changed since the last note.
Reported pain (0–10)
7 5
Down two points on the same scale used at the prior visit — carried forward automatically for the trend line.
MTUS / ACOEM alignment
Guideline check at point of care.
California’s Medical Treatment Utilization Schedule (MTUS) and the ACOEM Practice Guidelines together define the standard of care for occupational injuries under workers’ compensation. Treatment that deviates from MTUS requires explicit rationale and faces utilization-review challenge.
Chiron checks the proposed plan against MTUS and ACOEM with a decompose-retrieve- evaluate reasoning chain, powered by Eve-Healthcare™ F5/reasoner, grounded in retrieval over two dozen authentic California DWC guideline documents published by the Division of Workers’ Compensation (dir.ca.gov) — the real texts, not a paraphrase.
1. Decompose
The proposed plan is broken into discrete, checkable claims — diagnosis, modality, frequency, duration — rather than evaluated as one paragraph.
2. Retrieve
Each claim is retrieved against the ingested California DWC MTUS and ACOEM guideline documents — two dozen authentic published texts, the real language, not a paraphrase.
3. Evaluate
The retrieved passage is rated for how strongly it supports the claim, and the passage plus its citation are surfaced inline — the physician sees the guideline, not just a verdict.
ChironAI™ OMGuideline alignment check
Decision supportMust review before final
Decision-support output. Clinician review and attestation required before this content is signed into the chart.
Physical therapy, 2x/week for 4 weeks (8 visits) — lumbar strain
Strong supportMTUS Chronic Pain Medical Treatment Guidelines, retrieved passage. “A trial of physical medicine treatment is recommended for musculoskeletal injury, with functional improvement documented at reassessment.”
Representative excerpt — illustrates the citation format the product renders; confirm current guideline text at dir.ca.gov.
Repeat lumbar MRI at the 2-week follow-up
No verifiable MTUS / ACOEM match
Retrieval did not return a guideline passage that supports repeat imaging this early without new red-flag findings or a change in exam. Surfaced as an open flag rather than a suppressed gap or an invented citation — the physician decides.
The hallucination guard
When there is no guideline to cite, it says so.
Retrieval either returns a real, quotable passage that supports the plan, or it does not. When it does not, that is engineered to surface as an explicit “no verifiable match” flag — not a suppressed gap, and never an invented citation to fill the space. That is a trust moment by design: the same discipline that lets Chiron quote a guideline verbatim is the discipline that makes it say nothing when there is nothing to quote.
See how the reasoning is structured →Treatment-plan generation
Guardrails baked into the draft, not bolted on after.
Chiron drafts the treatment plan already checked against the guideline support tier above, and the drafting itself carries guardrails against the pitfalls that trigger a utilization-review denial — caught while the plan is still a draft, not after the request has already bounced.
UR-denial pitfall
Advanced imaging ordered before a documented conservative-care trial.
Guardrail that catches it
Flags the order if the chart does not yet show the guideline-concordant conservative-care trial — or the documented exception that justifies skipping it.
UR-denial pitfall
Modality frequency or duration that runs past the guideline-recommended course without a functional-improvement note.
Guardrail that catches it
Flags a plan that extends therapy without a documented functional gain — the exact pattern utilization review is trained to deny.
UR-denial pitfall
Opioid continuation past the point MTUS requires risk documentation.
Guardrail that catches it
Flags continued opioid therapy when the functional-goal reassessment and monitoring documentation MTUS requires is not yet on the chart.
UR-denial pitfall
A requested treatment with no MTUS / ACOEM indication for the diagnosis on record.
Guardrail that catches it
Surfaces the gap before the request goes out, with the nearest guideline-supported alternative for the physician to consider.
Structured work restrictions
Restrictions that move through the regulatory chain unchanged.
Lifting
Maximum weight (lb), frequency (occasional/frequent/constant), reach (floor to overhead).
Posture
Sitting, standing, walking with duration limits per hour and per shift.
Manual handling
Pushing, pulling, gripping, fine manipulation with force and frequency parameters.
Environmental
Climbing, ladders, heights, confined spaces, hazardous-environment exposures.
Cognitive
Sustained attention, complex decision-making, supervisory responsibility limits.
Restrictions composed once, exported to the DWC form, the employer modified-duty letter, and the patient-facing instructions — all from the same structured object. No transcription, no drift, no risk of inconsistency between surfaces.
ChironAI™ OMOne restriction, two destinations
Structured restriction (source)
Lifting: maximum 20 lb, occasional, floor to waist only.
DWC PR-2 — work status
Modified duty: lifting restricted to 20 lb maximum, occasional frequency, floor-to-waist reach only.
Employer modified-duty letter
The employee may return to modified duty. Please do not assign tasks requiring lifting over 20 lb, and limit lifting to occasional, floor-to-waist only.
Regulatory-deadline rail
The PR-2 clock, visible during the visit.
A DWC PR-2 progress report is due every 45 days of continuing care, or sooner on a material change — return to work, new disability, a change in the treatment plan. That deadline rides alongside the exam and plan, not buried in a separate worklist, so the physician sees it while still in the visit.
PR-2 approaching
Next PR-2 due within the current 45-day cadence, computed against the California state holiday calendar. The plan drafted in this visit becomes the basis for that report.
The full deadline arithmetic — Form 5021, PR-2 cadence, PS/MMI, and the daily 07:00 surfacing cron — is covered in depth on the DWC reporting page.
A note to the reader