Intellect™
REGISTRATION MENU OPTIONS
Worker
Add/Modify PR2, PR3, Pr4
PR4
Note: This option is not available for all software versions.
This screen is used to complete the PR4 in Intellect. See detailed instructions.
Updates:
Effective version 17.02.17, the program has been changed for PR2, PR3, PR4 and FIRST REPORT to auto-populate the screen fields with all 12 diagnosis codes from the most recent diagnoses/charge entry. The 12 Diagnosis codes from the PR screen also prints on the PR form.
The PR-4 form is required to be used for ratings prepared pursuant to the Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment. It is designed to be used by the primary treating physician to report the initial evaluation of permanent impairment to the claims administrator. It should be completed if the patient has residual effects from the injury or may require future medical care. In such cases, it should be completed once the patient's condition becomes permanent and stationary.
This screen contains drop-down list fields. For example, 
. For additional information on drop-down list fields, see Introduction to Intellect --►Intellect Characteristics and Features, Drop-down Lists.
This screen contains Text Box fields. To exit the field, either use the [Control] [Tab] keyboard combination two times, OR click on another field. An example of a Text Box field is:
Effective version 15.02.17, when printing via Registration --►Worker --►PR2 Form, PR3 Form, PR4 Form, or STPR, a comment stating “[report name] is printed” is inserted into the Ledger remarks on both the Ledger --►Accounting and Ledger --►Open Item screens for each patient for whom the report is run.
1. To complete the PR-4 in Intellect, go Registration --► Worker --► PR4 Form --► Add
The Add PR4 screen displays:
2. Patient Account 
2.1 Type the workers account number for whom to create this report.
2.2 Intellect completes the following Patient Section on sheet 1 of the DWC PR4 form from the patient demographic screen. Information must be completed during registration via Registration --►Worker --►Worker.
2.3 Intellect completes the following Administration Section of the DWC PR4 form from the patient insurance screen. Information must be completed during registration via Registration --►Worker --►Worker.
2.4 Intellect completes the following Employer Section of the DWC PR4 form from the patient insurance screen. Information must be completed during registration via Registration --►Worker --►Worker.
The field is mandatory and must be completed. If left blank, an error message displays:
Press the [Ok] button to return to the <Patient Account> field.
3. Patient Name 
3.1 The patient name displays last, first, middle initial. This is a read-only field and may not be accessed.
4.1 Effective version 14.1.10, this field is filled with the <DOI> field from the patient's P1 insurance on the Registration --►Worker --►Worker Insurance screen, if available.
4.2 If a <DOI> is not available on the Registration --►Worker --►Worker Insurance screen, and for versions prior to 14.11.10, type the actual date that the injury occurred. This field is mandatory.
4.3 This prints on sheet 1 of the DWC PR4 form, as shown below:
5. Date of Current Examination 
5.1 Type the date of this follow-up examination. This is mandatory.
5.2 This prints on sheet 1 of the DWC PR4 form, as shown below:
6.1 Type the date when the doctor declares the patient to be 'permanent and stationary'.
6.2 This does not necessarily mean that the condition will never change again. It does mean that the patient has reached a level where things are staying pretty much the same.
6.3 This prints on sheet 1 of the DWC PR4 form, as shown below:
7. Injury Description 
7.1 This is description of how injury/illness occurred (e.g., Hand caught in punch press; fell from height onto back; exposed 25 years ago to asbestos).
7.2 Type a detailed description.
7.3 This prints on sheet 1 of the DWC PR4 form, as shown below:
8.1 Type the patient’s description of injury or manifestations.
8.2 This prints on sheet 1 of the DWC PR4 form, as shown below:
9.1 Type the actual date that the patient last worked. This is mandatory.
9.2 This prints on sheet 1 of the DWC PR4 form, as shown below:
10.1 This field is not used for the DWC Form PR-4 (Rev. 10-2015).
11.1 Based on a physical exam, report all relevant findings as required by the AMA Guides, 5th Edition. Include any specific measurements indicating atrophy, range of motion, strength, etc. Include bilateral measurements - injured/uninjured - for injuries of the extremities.
11.2 This prints on sheet 2 of the DWC PR4 form, as shown below:
12.1 Type the results of any diagnostic tests including X-ray, lab, imaging etc.
12.2 This prints on sheet 2 of the DWC PR4 form, as shown below:
Information for all Diagnosis fields:
Effective version 15.09.02, if the date in the Utility --►Set Up --►Parameter <ICD10 Effective Date> field is equal to or greater than October 1, 2015, the following selection boxes are available for the <Diagnosis> fields:
• When an ICD-9 code is entered in the <Diagnosis> field, Intellect displays a selection list from which to choose an appropriate ICD-10 code. Highlight the appropriate ICD-10 code and click the [Select ICD-10] button, OR click [Exit] to close the selection screen.
• When either a keyword or partial ICD-10 diagnosis description is entered in the <Diagnosis> field, Intellect displays an ICD-10 Lookup screen which includes ICD-10 code options and the keyword/description entered in the <Diagnosis> field displayed in the <Search Phrase> field. For example, entering hand fracture in the <Diagnosis> field and pressing [Enter] displays:
[Back]: Click [Back] to restore the list to what it was prior to clicking the [Expand] button.
[Expand]: Click on a code displayed in blue and then click on [Expand] shows additional codes.
[Select]: Since the purpose of this program is only to find diagnosis codes, selecting a code is not necessary; therefore, click on [Select] to close the Look Up program.
[Exit]: Click [Exit] to close the Look Up program.
13.1 Effective version 16.02.22, there are twelve Diagnosis fields on this screen. The DWC PR4 form allows up to 12 diagnosis codes but the Intellect PR4 form screen pulls only the first four diagnoses codes posted in Charges --►Charge. If more than four diagnosis codes were posted, they need to be entered manually into the <Diagnosis> fields on the PR4 form screen. Diagnoses entered on this screen print on sheet 2 of the DWC PR4 form, in the area shown below.
13.2 Effective version 14.11.10, Intellect pulls the first three diagnoses posted to the patient record to fill the first three <Diagnosis> fields on this screen. In prior software versions, the diagnosis code(s)had to be typed into the <Diagnosis 1-3> fields.
13.3 If diagnoses codes have not yet been posted, and for versions prior to 14.11.10, enter the Diagnosis Code of the primary diagnosis. This data entry code notifies Intellect to print the appropriate ICD10 Code and description to the DWC PR4 report on Diagnoses line 1.
13.4 The Diagnosis code is a data entry code. Intellect prints the ICD10 Code and description to the report DWC PR4 on sheet 2.
14.1 Type the name of the impairment.
The U.S. Social Security, World Health Organization defines 'Impairment' as: The general concept is a definition which describes activities or functions, which have been changed or not, as a result of an injury or illness. It can be used for disability.
14.2 This prints on sheet 2 of the DWC PR4 form, as shown below.
Note: The field for Impairment 1 is not identified on the form, but prints approximately where the arrow indicates.
15. WPI % 1 
15.1 Report the whole person impairment (WPI) rating using the AMA current edition.
15.2 This concept is very important to understand when the physician qualifies an impairment at a certain range, and has to choose a number out of that range; i.e., 10-18% whole person impairment. What will make it 10% or 12% or 18%? One of the criteria is the clinical judgment of the physician, and no one else but the physician! Other factors such as activities of daily living 'ADL' are also important to assess the range.
15.3 This prints on sheet 2 of the DWC PR4 form, as shown below:
16. Table#(s) 1 
16.1 Type the AMA table designation from the current edition.
16.2 This prints on sheet 2 of the DWC PR4 form, as shown below:
17. Page#(s) 1 
17.1 Type the page number for the table.
17.2 This prints on sheet 2 of the DWC PR4 form, as shown below:
18. Explanation 1 
18.1 Type the physician’s explanation for this rating.
18.2 This prints on sheet 2 of the DWC PR4 form, as shown below:
19. Impairment 2 
19.1 Type the description of any additional impairment.
20. WPI% 2 
20.1 Report the whole person impairment 2 (WPI) rating using the AMA current edition.
21. Table#(s) 2 
21.1 Type the AMA table designation for impairment 2 from the AMA current edition.
22. Page#(s) 2 
22.1 Type the page number for the table for impairment 2 from the AMA current edition.
23. Explanation 2 
23.1 Type the physician's explanation for this rating for impairment 2.
24. Impairment 3 
24.1 Type the description of any additional impairment.
25. WPI% 3 
25.1 Report the whole person impairment 3 (WPI) rating using the AMA current edition.
26. Table#(s) 3 
26.1 Type the AMA table designation for impairment 3 from the AMA current edition.
27. Page#(s) 3 
27.1 Type the page number for the table for impairment 3.
28. Explanation 3 
28.1 Type the physician’s explanation for this rating for impairment 3.
29. Impairment 4 
29.1 Type the description of any additional impairment from the AMA current edition.
30. WPI% 4 
30.1 Report the whole person impairment 4 (WPI) rating from the AMA current edition.
31. Table#(s) 4 
31.1 Type the AMA table designation for impairment 4 from the AMA current edition.
32. Page#(s) 4 
32.1 Type the page number for the table for impairment 4 from the AMA current edition.
33. Explanation 4 
33.1 Type the physician's explanation for this rating for impairment 4.
34.1 Enter an assessment using the Impairment Rating Table.
35. Is the disability directly caused by injury? 
35.1 Accept the default 'Y' (yes), OR use the drop-down to make an alternate selection.
35.2 An 'X' is printed for the appropriate selection on sheet 4 of the DWC PR3 form:
36. Is the disability directly caused by other factor? 
36.1 Accept the default 'Y' (yes), OR use the drop-down to make an alternate selection.
36.2 An 'X' is printed for the appropriate selection on sheet 4 of the DWC PR3 form:
37.1 If 'Y' is selected for the <Is the disability directly caused by other factor?> field above, please provide this necessary information:
(1) the approximate percentage of the permanent disability that is due to factors other than the injury or illness arising out of and in the course of employment.
- and -
(2) a complete narrative description of the basis for the apportionment finding. If it is not possible to include an apportionment determination in the report, state the specific reasons why the determination cannot be made.
37.2 Intellect prints this explanation on page 4 of the DWC PR4 form.
38. Future Medical Treatment 
38.1 Describe any continuing or expected medical treatment related to this injury that must be provided to the patient. 'Continuing medical treatment' is defined as occurring or presently planned treatment. Also, describe any medical treatment the patient may require in the future. ('Future medical treatment' is defined as treatment which is anticipated at some time in the future to cure or relieve the employee from the effects of the injury.) Include medications, surgery, physical medicine services, durable equipment, etc.
38.2 Intellect prints this explanation on page 4 of the DWC PR4 form.
39. Medical Treatment Comment 
39.1 This field is not used for the DWC Form PR-4 (Rev. 10-2015).
NOTE: The following assessment of functional capacity is to be prepared by the treating physician, solely for the purpose of determining a claimant’s ability to return to his or her usual and customary occupation, and is not considered in the permanent impairment rating.
40. Limited Lift/Carry 
40.1 Select the weight indicating the patient’s ability (no matter how minor) to lift/ carry objects.
40.2 Accept the default blank if 'none,' OR use the drop-down to make an alternate selection.
40.3 An 'X' is printed for the appropriate selection on sheet 4 of the DWC PR4 form:
41. Frequently Lift/Carry 
41.1 Select the weight indicating the patient's ability to frequently lift/carry objects.
41.2 Accept the default blank if 'none,' OR use the drop-down to make an alternate selection.
41.3 An 'X' is printed for the appropriate selection on sheet 4 of the DWC PR4 form:
42. Occasionally Lift/Carry 
42.1 Select the weight indicating the patient's ability to occasionally lift/carry objects.
42.2 Accept the default blank if 'none,' OR use the drop-down to make an alternate selection.
42.3 An 'X' is printed for the appropriate selection on sheet 4 of the DWC PR4 form:
43. Stand/Walk 
43.1 This indicates the amount of time the patient is able to stand/walk.
43.2 Accept the default 'less than 2 hours per 8 hour day' OR use the drop-down to make an alternate selection.
43.3 An 'X' is printed on sheet 4 of the DWC PR4 form, in the area indicated below.
Note: The DWC PR4 form incorrectly shows 'lbs' instead of 'hours'. Please refer to the chart below for clarification:
|
If this is selected: |
An 'X' is printed in the box labeled: |
|
less than 2 hours per 8 hour day |
10 lbs |
|
less than 4 hours per 8 hour day |
20 lbs |
|
less than 6 hours per 8 hour day |
30 lbs |
|
less than 8 hours per 8 hour day |
40 lbs |
44. Sit 
44.1 Indicate the patient's ability to sit up.
44.2 Accept the default 'less than 2 hours per 8 hour day' OR use the drop-down to make an alternate selection.
44.3 An 'X' is printed for the appropriate selection on sheet 4 of the DWC PR4 form:
45. Push/Pull 
45.1 Indicate whether or not the patient has the ability to sit and push/pull objects.
45.2 Accept the default unlimited, OR use the drop-down to indicate limited (if limited, manually enter a description after printing the form).
45.3 An 'X' is printed for the appropriate selection on sheet 4 of the DWC PR4 form:
46. Allowed Climbing 
46.1 To what degree does the medical condition permit the patient to climb?
46.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form:
47. Allowed Balancing 
47.1 How often is balance an issue?
47.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
48. Allowed Stooping 
48.1 How often does the medical condition permit the patient to stoop?
48.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
49. Allowed Kneeling 
49.1 How often does the medical condition permit the patient to kneel?
49.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
50. Allowed Crouching 
50.1 How often does the medical condition permit the patient to crouch?
50.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
51. Allowed Crawling 
51.1 How often does the medical condition permit the patient to crawl?
51.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
52. Allowed Twisting 
52.1 How often does the medical condition permit the patient to twist the body?
52.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
53. Allowed Reaching 
53.1 How often does the medical condition permit the patient to reach?
53.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
54. Allowed Handling 
54.1 How often does the medical condition permit the patient to handle? Handling is defined as 'the act of touching, feeling, holding, or moving something'.
54.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
55. Allowed Fingering 
55.1 How often does the medical condition permit the patient to finger? Fingering is defined as 'the action or method of using the fingers in performing a task'.
55.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
56. Allowed Feeling 
56.1 How often does the medical condition permit the patient to feel; i.e., touch?
56.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
57. Allowed Seeing 
57.1 How often does the medical condition permit the patient to see?
57.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
58. Allowed Hearing 
58.1 How often does the medical condition permit the patient to hear?
58.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
59. Allowed Speaking 
59.1 How often does the medical condition permit the patient to speak?
59.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form.
60. Impaired Activities 
60.1 Describe any impairment listed above.
60.2 Intellect prints the entered text on sheet 5 of the DWC PR4 form.
61.1 Describe any environmental restrictions due to the patient’s condition.
61.2 Intellect prints the entered text on sheet 5 of the DWC PR4 form.
62. Can Return To Work 
62.1 Accept the default 'Y' (yes) if the patient can return to work, OR use the drop-down to select 'N' (no).
62.2 An 'X' is printed for the appropriate selection on sheet 5 of the DWC PR4 form:
63. Medical Record 
63.1 List information that was reviewed, or relied upon, for the formulation of the medical opinion in preparing this report, relating to medical records.
63.2 Intellect prints the entered text on sheet 5 of the DWC PR4 form.
64. Job Description 
64.1 List information that was reviewed in preparing this report, or relied upon for the formulation of the medical opinions, relating to the job description.
64.2 Intellect prints the entered text on sheet 5 of the DWC PR4 form.
65. Other Comment 
65.1 List any additional relevant comments that influenced the preparation of this report.
65.2 Intellect prints the entered text on sheet 6 of the DWC PR4 form.
66. When the information has been completely entered, select one of these options:
66.1 Press [Add] to save the record and return the focus to the <Account> field with the current Account No active.
66.2 Press [Clear] to bring up this prompt:
66.2.1 Click [No] to clear and return the focus to the Account field with the current account active.
66.2.2 Click [Yes] to save the record.
66.3 Press [Exit] to bring up this prompt:
66.3.1 Click [No] to clear and return the focus to the main Intellect screen without saving.
66.3.2 Click [Yes] to save the record, and then clear and return the focus to the main Intellect screen.
NOTE: PR4 forms may be printed from two places within Intellect. For more information on printing the PR4 form, refer to sections for either:
· Registration --► Worker --► PR4 Form --► Search. This option allows a form to be printed for either one or all of the PR4 records entered for the patient.
· Registration --► Worker --► PR Forms Printing --► either Batch or Group of PR Forms Printing
