Soft tissue injury evaluation

Car Accidents — Initial evaluation — Soft tissue injury evaluation

If you have been injured in a car accident you are generally entitled to recover for all past and future injuries that you have suffered. Some personal injuries are very easy to evaluate, others are more difficult.

Soft tissue injuries are injuries to muscles, ligaments, or tendons. They can result in tears, sprains, strains, swelling, bruising, and general pain.

If you have soft tissue injuries your personal injury lawyer may use a worksheet similar to the following sample to identify the key relevant information and issues for your lawsuit.

SOFT TISSUE WORKSHEET

CLAIMANT:_______________________________________

INJURY DIAGNOSIS:________________________________________________

First Spine Treatment Date _____________Nature of Initial Treatment__________

Evidence of Pre-Existing Injury Y/N Nature of Pre-Existing Injury_____________

Most Recent Pre-Accident Treatment:_______________ Prior PPD%____________

Specialist Visits: _____________________________________________________
(Dates)_________________________________________________________________

GP or Outpatient ER: ___________________________________________________
(Dates)_________________________________________________________________

Chiropractor Visits: ___________________________________________________
(Dates) ________________________________________________________________

Spine Treatments:
Immobilization____ Physical Therapy____ Home Exercise____ MRI/CT____

Rx Meds. _______ TENS_______ Home Traction_____ Injections_________

History Physical Therapy:
Home Exercise: Short Term<3 months______ Long Term>3months_______

Physical Therapy: Short Term Regular (up to 3 mos., 1 or 2x week) ________
Short Term Intensive (up to 3 mos., over 3x week) ______
Prolonged Regular (over 3 mos., 1 or 2x week) __________
Prolonged Intensive (over 3 mos., over 3x week) ________

Soft Tissue Complaints:
Spasm ____ ROM ______ Radiating Pain _______ Anxiety/Depression______

Headaches _____ Di9zziness _____ Vision Disturbance ________

Lapse/Delay in Treatment:
Total Weeks ________________ Longest Lapse/Delay in Weeks_______________

Duties Under Duress:
Work ____ Domestic _______ Household ____ Studies____ Complaints_____

Impairment:
Subjective ________ % Objective _________%

Independent Medical Exams:
Plaintiff_______ Defendant ______ Examiner and Findings ____________________

_____________________________________________________________________

Disfigurement:
Describe and Value: _____________________________________________________

Loss of Enjoyment of Life:
Describe and Value: ____________________________________________________

Special Damages:
Medical Specials $ ______ (Collateral Sources $ _____) = Net Medical ______

Loss Earnings $ _______ (Adjustments $ _______) = Net Lost Earnings _______

Contributions/Offsets:
Nature and Amount $ ___________________________________________________

Aggravating Factors:
Seatbelt? Y/N Attorney Rep.? Y/N Aggravated Liability?: Y/N

Wearing a helmet? Y/N Prop. Damage $ _________________