Made An Imo Format - May I Have Your Thoughts?

[hedgey]

I figured that when going to see the Dr, it might help if I had a 'form' partly filled in and ready for them to just add a line or two and a signature. I used one I saw here or somewhere online, and adjusted it a little. I'd really like to know what anyone thinks about it:

Veteran's Name: ________________________________________________________

Veteran's File Number _______________________

Diagnosis/Condition_______________________________________________________

Practitioner's Name ______________________________________________________

Practitioner's Address ____________________________________________________

_____________________________________________________

Practitioner's Phone _____________________________________________________

In my medical opinion, the currently existing medical condition is (please check one)

__________ Related to

__________Likely related to

__________At least as likely as not related to

an injury, disease, or event occurring during the veteran's military service.

Related injury or illness occurring during service (as described by veteran or as found in records provided by veteran):

_______________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Signature and Title of Practitioner Date

Signature of Veteran Date

I don't know what's up with the spacey formatting it looks much neater in Word....

[pilgrim01]

I figured that when going to see the Dr, it might help if I had a 'form' partly filled in and ready for them to just add a line or two and a signature. I used one I saw here or somewhere online, and adjusted it a little. I'd really like to know what anyone thinks about it:

Veteran's Name: ________________________________________________________

Veteran's File Number _______________________

Diagnosis/Condition_______________________________________________________

Practitioner's Name ______________________________________________________

Practitioner's Address ____________________________________________________

_____________________________________________________

Practitioner's Phone _____________________________________________________

In my medical opinion, the currently existing medical condition is (please check one)

__________ Related to

__________Likely related to

__________At least as likely as not related to

an injury, disease, or event occurring during the veteran's military service.

Related injury or illness occurring during service (as described by veteran or as found in records provided by veteran):

_______________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Signature and Title of Practitioner Date

Signature of Veteran Date

I don't know what's up with the spacey formatting it looks much neater in Word....

I love it. I hope it passes the test with the "experienced guys/gals" on here because I will be using it in about 2 weeks! :D

[Pete53]

Actually you can help the Doc by filling out most of the form except where the Doc needs to do their thing. Most Docs don't like to sign off on blank spots.

Other than that it looks ok to me.

[jerrbilly]

Looks good. I would let the doc do the whole thing. If he's willing to write up an opinion he would be ok with checking the corresponding box I would think.

Do you have a good relationship with your doc? This definetely helps.

Hopefully your doc will be straight forward and right to the point. Good luck with the IMO.

[john999]

I think I would strike "related to" and replace it with "caused by", as in "the veteran's depression is at least as likely caused by his military service".

[Berta]

I agree that the terms- as likely as not or more than likely are best to use as this is what the VA is familiar with.

Also the doc needs to give a full medical rationale for their opinion. They can refer to and cite any established medical texts or treatises and should cite their experience medically that gives their opinion validity.

They should add a Curriculum Vitae if possible and - as I mentioned in the IMO forum here- if this is a mental disability claim-they should state that the veteran is competent to handle their own funds.

This is good however as many IMO doctors need to know the proper format for these IMOs.

[hedgey]

Oh, I forgot there was an IMO section! :D

Thanks for all the input, everybody. No, I don't have much of a relationship with the doc at all - it's been he!! finding one to take new patients at all, and I don't know what to expect when I ask for an IMO. The VA PCP flat out refused to do one for me... first she said that she wasn't allowed to, and then months later when I asked again, she said she had no way of knowing if my secondary problems were related to my injury. But she was also of the type to dismiss everything as normal aging and that I have to expect aches and pains to develop (funny how only my right knee and hip are aging, isn't it?). She also said that since the x-ray didn't show anything wrong with my hip, there is nothing wrong with my hip.

But I digress.

I will change "related to" to "caused by". And I'll add the "More than likely" choice, too. I hope that the doctor will be willing to put more detailed information in his notes so I can send a copy of them to the VA. I don't know whether I can rely on him to do that much for me. I figured this prepared sheet will at least get a doctor's statement in writing, at minimum.

Thanks again :D