A PM&R course, from intake link to the next request

A PM&R clinic takes on a worker with a lumbar strain and a shoulder injury. Before the first visit, staff email her an intake link, and she completes it on her phone in Spanish, marking where it hurts on the body diagram. Her answers flag a positive two-question mood screen, which Chiron shows at the top of the intake and beside the visit note for the physician to review; the worker is never told she has anything.

In the visit, one click puts her chief complaint, mechanism, job and pain into the empty fields of the note, labelled as the patient's report. The physician runs the Jamar grip protocol, and Chiron calculates the side-to-side percentages and variation, then reports spine range of motion against the AMA Guides normals and the Waddell sign count. The physician uploads the PDF an EMG machine printed for her nerve-conduction study, and Chiron reads its tables into a draft for the physician to confirm row by row. Chiron carries her work restrictions onto the PR-2 and the work-status letter.

Over the next weeks Chiron counts her physical therapy visits against the statutory cap and the number the claims administrator authorized, and warns before she reaches the limit. Her pain and function questionnaires chart a trend the physician can show a reviewer. The physician has prescribed a short course of an opioid, so Chiron calculates her morphine-milligram-equivalent dose from the prescriptions issued and reminds the physician about a urine drug test, a pain agreement and a CURES review, which the physician carries out in the State's system and records in OM.

When the physician wants to add a course of treatment, Chiron checks the request against MTUS/ACOEM and quotes the guideline. Before it goes out, the PM&R denial-risk check shows what a utilization reviewer may ask about and what documentation to add. The physician adds a line on functional improvement, signs the RFA and sends it.