The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) Fourth Edition, is based on fundamental principles, particularly Chapter 1, Impairment Evaluations, Chapter 2, Records and Reports, and the Glossary. This article (continued in the next issue) discusses and clarifies 21 key principles for using the AMA Guides. For example, the AMA Guides applies only to permanent impairments, and impairment percentages are estimates, not precise determinations. All impairment ratings should be combined to express an impairment of the whole person. The AMA Guides establishes an evaluation process, and the medical rating itself is not the process or purpose addressed. An impairment estimate is simply a number and does not convey information about the effects of the impairment on the person's activities of daily living. A definition of normal requires nuanced evaluations in which physicians are asked to express opinions about the absence or presence of disability. Examiners should evaluate the patient's full range of possible active motion without the application of moderate pressure to the joint. Some patients with extremity pain or other symptoms may not have evidence of permanent impairment, and if the effects on different organ systems contribute to impairment, these estimates should be combined. [Continued in the March/April 1997 The Guides Newsletter]

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