AiM ANALYSIS REPORT Corporate Office: 16460 Bake Pkwy Irvine, CA 92618 AMA MEASUREMENT ANALYSIS CONSULTATION REPORT Patient SSN TrueMRI ID Date of Birth Referring Doctor Study Location Study Date Study Type XXXXXXXXX 548-45-XXX1025162 12/22/65 Van Vu ,MD TrueMRI-Newport Beach 06/13/07 & 4/3/08 This is a specialty radiology consultation report that will provide the referring physician with data and radiologic analysis necessary to help determine the impairment rating according to criteria set forth in AMA Guides (Guides to the Evaluation of Permanent Impairment, 5th Edition. Cocchiarella L and Andersson GBJ. AMA Press 2001). All references to Diagnosis Related Estimate (DRE) categorization are based on Table 15-5 of the AMA Guides (page 392). All references to the “Diagnosis Based” component (DB) for ROM categorization are based on Table 15-7 of the AMA Guides (page 404). This consultation report is performed in addition to the routine MRI and or Plain Film professional interpretation report that was generated and reported separately. Analyses are based on factors that may impact either the DRE categorization or the ROM categorization of the patient. The purpose of this report is to assist the rating physician with the data necessary to assign the appropriate impairment rating by assimilating these radiologic findings with the clinical and historical findings to determine the impairment rating. PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com FINDINGS PDF created with pdfFactory trial version www.pdffactory.com