IME chronology sample: a right shoulder after a crash
Answer in brief: an IME chronology is built around the referral letter. Every row carries a tag for the question it helps answer, prior care on the same body part sits at the top, and history that conflicts with earlier records is shown side by side. This sample does all 3 on a 212-page synthetic file, no real patient.
Limits: Every sample here is synthetic: no real patient, invented names and invented page numbers. Rules quoted for QME and Social Security work come from the cited regulation, read 2026-11-12; they are not legal advice, and facts about other sample libraries come from each publisher's page on that date.
The synthetic file
| Examinee | Patient B, 54, delivery driver. Invented. |
|---|---|
| Event | Car crash on 2024-02-09, restrained driver, struck on the passenger side |
| Requested by | An auto liability carrier, for a records review and exam |
| File | 212 pages from 7 sources: family practice, emergency department, imaging center, physical therapy, orthopedics, surgery center, billing. 9 pages set aside: a duplicate MRI report (2 pages) filed in the orthopedic records, 4 fax cover sheets, 3 billing ledger pages. |
| Referral questions | Q1: Is the right shoulder condition related to the 2024-02-09 crash? Q2: Was the treatment, including surgery, reasonable and related? Q3: Was there a pre-existing condition, and was it aggravated? Q4: What is the current status, and is more care needed? |
The sample IME chronology
12 rows. The Q column holds the referral questions each row bears on. Notes link to the annotations below the table.
| Date | Source | Type | What the record says | Page | Q | Note |
|---|---|---|---|---|---|---|
| 2023-06-14 | L. Moreno, MD, Northside Family Practice | Office note | Right shoulder pain for 3 months, worse reaching overhead. Positive impingement signs. Subacromial corticosteroid injection given. | 18-19 | Q1, Q3 | Prior A1 |
| 2024-02-09 | T. Adeyemi, MD, Lakeview Regional ED | ED note, x-ray | Neck and right shoulder pain after the crash. "Full passive range of motion, pain at end range." X-ray right shoulder: "no fracture or dislocation." | 34-39 | Q1 | Verbatim A2 |
| 2024-02-16 | L. Moreno, MD, Northside Family Practice | Office note | "R shoulder pain since MVC 02/09." History section: "no prior shoulder problems." Referred to PT. | 22-23 | Q3 | Conflict with 2023-06-14 A3 |
| 2024-03-05 to 2024-04-23 | Coastline Physical Therapy | PT series, 14 visits | Flexion 110 degrees at evaluation, 150 at visit 14. Pain 6/10 to 3/10. Discharged to home program. | 61-104 | Q2, Q4 | Series A4 |
| 2024-05-02 | K. Shah, MD, Bayview Imaging | MRI right shoulder | Impression: "partial-thickness articular-sided tear of the supraspinatus. Moderate acromioclavicular joint arthrosis with inferior osteophyte. Type 2 acromion." | 41-42 | Q1, Q3 | Verbatim A5 |
| 2024-05-20 | D. Lindqvist, MD, Harbor Orthopedics | Consult | "Patient reports an injection in 2023 that helped for several months." Recommends arthroscopic subacromial decompression and debridement. | 120-126 | Q2, Q3 | Resolves A3 in part A6 |
| 2024-05-21 to 2024-09-10 | None in file | Gap | No shoulder care: 114 days from the 2024-05-20 consult to the 2024-09-11 visit. | n/a | Q2 | Gap A7 |
| 2024-09-11 | D. Lindqvist, MD, Harbor Orthopedics | Follow-up | "Pain persists despite home exercise. Patient wanted to try to avoid surgery over the summer." Second subacromial injection. | 127-129 | Q2 | Explains gap |
| 2024-11-18 | D. Lindqvist, MD, Harbor Orthopedics | Follow-up | Injection relief "about 3 weeks." Surgery scheduled. No statement on maximum improvement. | 130-131 | Q2, Q4 | |
| 2025-01-14 | D. Lindqvist, MD, Harbor Surgery Center | Operative report | Arthroscopic subacromial decompression, distal clavicle excision, debridement. Findings: "partial-thickness supraspinatus tear, less than 50 percent of tendon thickness, frayed margins; large AC spur." | 150-158 | Q1, Q2, Q3 | Verbatim A8 |
| 2025-03-10 | Coastline Physical Therapy | PT discharge | Flexion 165 degrees. Pain 1/10. Goals met. | 190-191 | Q4 | |
| 2025-04-07 | D. Lindqvist, MD, Harbor Orthopedics | Final visit | "Doing well. Return as needed." No restrictions listed. | 132-133 | Q4 | Last record |
Annotations: why each row reads the way it does
- A1, prior care goes first. The 2023 visit is 8 months before the crash, same shoulder, same complaint pattern. It belongs in the chronology even though the referring party did not mention it, because Q3 asks about it directly. The row records what was done (an injection), not what it means.
- A2, quote the first exam. The first exam after an event is the baseline for Q1. "Full passive range of motion" is quoted, not paraphrased as "normal exam", because the examiner may need to read it back word for word.
- A3, show the conflict, do not fix it. 1 week after the crash the same practice records "no prior shoulder problems". The row quotes it and points to the 2023 row. The chronology does not decide whether the patient forgot, the form was copied forward, or something else happened. That is the examiner's call.
- A4, group therapy visits. 14 PT notes become 1 row with the first and last measures and the full page range. Listing 14 near-identical rows hides the trend that answers Q2 and Q4.
- A5, keep the radiologist's chronic words. "Arthrosis", "osteophyte" and "type 2 acromion" describe changes that take time to form. The row quotes them because Q3 turns on them. A duplicate of this report sits in the orthopedic records at pages 134-135; it is logged as set aside, not given a second row.
- A6, a later note can narrow a conflict. The orthopedic consult records the 2023 injection. That does not erase the conflict in A3, but it shows the history reached at least 1 treating physician. The note column says "resolves in part", not "resolved".
- A7, gaps get their own row. 114 days with no shoulder care sits between 2 rows that would otherwise look continuous. The next row quotes the patient's reason. Gap rows carry no page because there is no page; they say "n/a" so nobody hunts for one.
- A8, operative findings over imaging. The surgeon saw the tendon. "Less than 50 percent of tendon thickness" and "large AC spur" are quoted because they bear on all of Q1 to Q3, and the examiner will compare them with the MRI.
What an IME chronology adds to a base table
- The Q column. Tagging rows to referral questions does 2 jobs: it shows which questions have thin support, and it shows rows that answer nothing and can go.
- Prior records first. Pre-event records on the same body part belong at the top, even when the referral letter is silent on them.
- A clear last record. The final row tells the examiner where the file stops. Q4 is answered from the exam, but the record tells you what the treating doctor said last.
Common misses in IME chronologies
- Dropping the pre-event record because it came from a different provider than the post-event care.
- Writing "denies prior history" without the page, so the examiner cannot show where it came from.
- Counting the duplicate MRI as a second study.
- Summarizing the operative report as "rotator cuff repair" when no repair was done. Debridement and repair are different procedures and different answers to Q2.
- No row for the gap, so the summer reads as continuous care.
Questions about IME chronology samples
Should an IME chronology include records from before the injury?
Yes, for the same body part or a related condition. Pre-injury care is often the deciding fact for causation and aggravation questions.
Should the chronology say whether the crash caused the tear?
No. The chronology reports what each record says. The causation opinion belongs in the IME report, signed by the examiner.