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Certified,
Impairment & California Workers Compensation Disability Rating
Specialists American
College of Disability Medicine & American Board of Independent Medical
Examiners |
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Luis Pérez-Cordero / pdrating@pacbell.net Craig A. Lange /craigalange@pacbell.net |
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Voice: (415) 861-4040 / Main
Fax: (415) 276-3741 |
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PD Rating Request Form ¯ (X) Check Required Service |
Check for Rush
Service: |
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¡ 1 Business Day $50 |
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¡ Same Business Day $75 |
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¡ 2
Business Days $40 |
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¡Basic Rating: Disability Formulas based on reported
Impairment with mathematical corrections only. Adjustments
under either the 2005PDRS or 97PDRS. When this box is checked & report does not comply with
the AMA Guides, we will provide a Comprehensive Rating. For One Body Region /Med Rpt.
$75-95 (For Three or More Regions / Multiple
Reports: $125-175+) |
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¡Comprehensive Rating: Disability Formulas &
Verifies
report WPI calculations comply with AMA Guides & California rating criteria.
Corrects misapplications of AMA Guides Rating Criteria and miscalculations of
WPI. Combines multiple disabilities as per 05PDRS Guidelines. If supplemental
report is required, analysis specifies information to be addressed by evaluating
physician. $115-225+ |
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¡Multifaceted Analysis or DEU / Private
Rating Reviews: Addresses deficiencies & inconsistencies of
the report, DEU or Private Rating to established procedures: AMA Guides,
97PDRS or 05PDRS, California & WCAB Guidelines. Findings are checked with
the Guides criteria to determine the proper calculation of impairment and
disability. Ratings based on reported findings at MMI
(P&S) date. (Comparative & Recommended Formulas Included) $145-225+ |
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¡Almaraz/Guzman
Impairment Analysis: Provides disability Formulas for both the correct
AMA Guides Rating and the alternative impairment ratings under
Almaraz-Guzman. Considers Duplication
among all Impairments within the multiple evaluations for different body
organs / systems. Addresses deficiencies &
inconsistencies of the report, the correct rating under the AMA Guides or the
alternative rating to the AMA 5th Edition. $225+ |
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¡Impairment-As-Reported
Rating: Request this rating
service when a rating of impairment as
reported in the medical report is needed, but no analysis is
required. A rating will be given with only corrections to
mathematical miscalculations of impairment. Formulas abide
to 05/97PDRS rating, modifiers & combination guidelines. $75-95 (For 3 or More Regions / Multiple Reports:
$125-175+) |
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Check (X): Return Via |
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¡ E-Mail |
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¡ Fax |
Schedule |
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¡97PDRS |
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¡05PDRS |
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E-Mail Address |
Fax Phone # |
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Name of Requestor |
Direct Voice Phone # w/Ext |
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Carrier/Adjusting
Agency/Employer |
Claim/File
# / WCAB File # / DEU # |
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Employee Name |
SS # |
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Employer |
Occupation |
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Date
of Injury / CT Date |
Date
of Birth / Age On DOI |
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Injury To (Joint /
Organ / Body Segment or Systems) |
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Check (X): Medical Report |
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¡
PTP |
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¡
PTP Consult |
Remarks/Other: |
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¡
PQME |
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AQME |
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DQME |
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AME |
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¡
IME |
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¡ Med File * |
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To mail a
complete file/multiple reports: email craigalange@pacbell.net for mailing address. |
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On-Line
Service Request Form: http://www.pdratings.com/ratingrequest.html |
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