Requirements For The “Mir Report.”

(1) After conducting the evaluation, the MIR physician shall produce the “MIR Report.” The format, available by using the Program’s electronic access, available upon request from the Program Coordinator or available online at www.state.tn.us/labor-wfd/mainforms.html, or a materially substantial equivalent approved by the Program Coordinator shall be used in all cases to detail the evaluation’s results. The MIR physician shall first review the determination by the attending physician that the claimant has reached Maximum Medical Improvement (MMI). (2) If, after reviewing the records, taking a history from the claimant and performing the evaluation, the MIR Registry physician concurs with the attending doctor’s determination of MMI, the report shall, at a minimum, contain the following: (a) A brief description and overview of the claimant’s medical history as it relates to the subject injury, including reviewing and recapping all previous treatments. (b) A statement of concurrence with the attending doctor’s determination of MMI; (c) Pertinent details of the physical or psychiatric evaluation performed (both positive and negative findings); (d) An impairment rating consistent with the findings and utilizing a standard method as outlined in the applicable AMA Guides™, calculated as a total to the whole person if appropriate. In cases not covered by the AMA Guides™, an impairment rating by any MEDICAL IMPAIRMENT RATING REGISTRY PROGRAM CHAPTER 0800-02-20 appropriate method used and accepted by the medical community is allowed, however, a statement that the AMA Guides™ fails to cover the case as well as a statement of the system on which the rating was based shall be included; (e) The rationale for the rating based on reasonable medical certainty, supported by specific references to the clinical findings, especially objective findings and supporting documentation including the specific rating system, sections, tables, figures, and AMA Guides™ page numbers, when appropriate, to clearly show how the rating was derived; and (f) A true or electronic signature and date by the MIR physician performing the evaluation certifying to the following: 1. “It is my opinion, both within and to a reasonable degree of medical certainty that, based upon all information available to me at the time of the MIR impairment evaluation and by utilizing the relevant AMA Guides™ or other appropriate method as noted above, the claimant has the permanent impairment so described in this report. I certify that the opinion furnished is my own, that this document accurately reflects my opinion, and that I am aware that my signature attests to its truthfulness. I further certify that my statement of qualifications to serve on the MIR Registry is both current and completely accurate.” (3) If, after reviewing the records, taking a history from the claimant and performing the evaluation, the MIR physician does not concur with the attending doctor’s determination of MMI, a report shall be completed similar to the one outlined above which documents and certifies to, in sufficient detail, the rationale for disagreeing. The physician is still entitled to collect/retain the appropriate MIR fee. Even if the claimant is determined not to be at MMI by the MIR physician, the MIR physician will still issue a completed MIR report with a permanent medical impairment rating based upon the findings at the time of evaluation. (4) Services rendered by an MIR Registry physician shall conclude upon the Program Coordinator’s acceptance of the final “MIR Report.” An MIR report is final and accepted for the purpose of these Rules when it includes the requested determination regarding final medical impairment rating, along with any necessary worksheets, and is signed by the Program Coordinator. Once the report has been accepted, the Program Coordinator will distribute copies of the report to the parties and the Mediation Specialist, if one is currently assigned. (5) After acceptance of the “MIR Report” the medical records file, including the final “MIR Report,” shall be stored and/or disposed of by the MIR Physician in a manner used for similar health records containing private information and within a time frame consistent with all applicable federal, state and local laws and the Tennessee Board of Medical Examiners’ rules. (6) Any addendums or changes to the MIR Report after it has been deemed accepted shall be approved and signed by the Program Coordinator prior to distribution to the parties.