Get Ie Piab Medical Assessment Form (form B) 2021-2025

Filling out the IE PIAB Medical Assessment Form (Form B) online is a crucial step in the personal injury claim process. This guide will provide clear, step-by-step instructions to assist users in accurately completing the form to ensure that all necessary medical information is submitted for assessment.

Follow the steps to submit your medical assessment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, enter the PIAB application number and provide the examining doctor's name. Make sure to include the claimant's name, address, gender, and date of birth.
3. Next, indicate the claimant's occupation and document whether they are currently at work. Specify whether the claimant is right or left hand dominant, along with their height and weight.
4. Provide details on the date of the accident and the examination date, along with the total time elapsed since the accident to the examination date.
5. In the accident details section, describe the dominant and other significant injuries sustained. Include the history of conditions immediately after the accident and in the following days.
6. Document the date the claimant first sought treatment and from whom they received it. Indicate if the claimant was hospitalized, including the duration of the inpatient stay and the total length of absence from work.
7. Record the number of visits to general practitioners and specialists, along with any treatments and investigations to date.
8. Fill in the World Health Organisation International Classification of Diseases (ICD) codes relevant to the dominant injury.
9. Complete the relevant medical history section, indicating any aggravation of pre-existing conditions or additional accidents.
10. In the present complaints section, assess how the injuries have impacted the claimant's lifestyle and employment.
11. Provide clinical findings on examination. Include photographs of any relevant scarring as necessary.
12. Summarize the opinion and prognosis, including any anticipated future treatment required and whether further investigations are needed.
13. Once all sections are complete, ensure accuracy and save changes. You can then download, print, or share the completed form as needed.

Complete your IE PIAB Medical Assessment Form (Form B) online today to facilitate your personal injury claim.