QME chronology sample: cumulative trauma to both wrists
Answer in brief: a California QME chronology needs 3 things a general chronology does not: a column showing who excerpted each record and that the evaluator checked it, tags for factors the evaluator may weigh on apportionment, and a records-reviewed list that ends in a page count. This sample shows all 3 on a 486-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
| Applicant | Patient C, 47, grocery checker for 11 years. Invented. |
|---|---|
| Claim | Cumulative trauma to both wrists and hands, claimed period 2021-04-01 to 2023-04-10 |
| Evaluation | Panel QME, initial evaluation billed under ML201, orthopedic surgery |
| File | 486 pages in 13 groups from 10 sources, served by both parties. 41 pages are second copies of the treating physician's reports, served by the other side. |
| Issues listed | Injury arising out of employment, permanent and stationary status, impairment, apportionment, future medical care |
The sample QME chronology
13 rows. "Excerpt" shows who drafted the row and when the evaluator checked it against the page. "Factor" tags facts the evaluator may weigh on apportionment; it is a pointer, not a finding.
| Date | Source | Type | What the record says | Page | Excerpt | Factor | Note |
|---|---|---|---|---|---|---|---|
| 2019-08-12 | A. Iqbal, MD, Valley Community Clinic | Internal medicine note | Hemoglobin A1c 7.4. "New diagnosis type 2 diabetes." Metformin started. | 12-14 | Staff; QME checked 2024-09-20 | Other factor to weigh | Prior A1 |
| 2020-03-03 | A. Iqbal, MD, Valley Community Clinic | Internal medicine note | TSH 8.9. Hypothyroidism. Levothyroxine started. | 15-16 | Staff; QME checked 2024-09-20 | Other factor to weigh | Prior A1 |
| 2022-11-07 | A. Iqbal, MD, Valley Community Clinic | Internal medicine note | "Numbness both hands at night x 2 months. Works as cashier." Wrist splints advised. | 21-22 | QME | Onset | First mention A2 |
| 2023-04-10 | Applicant | DWC-1 claim form | Both wrists and hands, "repetitive scanning and bagging." Period stated as above. | 2-3 | Staff; QME checked 2024-09-20 | Work exposure | Non-medical A3 |
| 2023-04-19 | R. Castaneda, MD, occupational medicine (treating) | Doctor's First Report | Scans about 8 hours a shift. Tinel and Phalen positive both wrists. Diagnosis bilateral carpal tunnel syndrome. Modified duty: no repetitive gripping over 30 minutes an hour. | 30-35 | QME | Work exposure | |
| 2023-05-22 | P. Huang, MD | EMG and nerve conduction | "Moderate median neuropathy at the wrist on the right, mild on the left. No cervical radiculopathy." | 48-51 | QME | Verbatim | |
| 2023-06-14 | Utilization review | UR decision | Right carpal tunnel release: certified. | 60-61 | Staff; QME checked 2024-09-20 | A4 | |
| 2023-07-25 | J. Ortega, MD, hand surgery | Operative report | Right open carpal tunnel release. "Median nerve flattened with hourglass narrowing." | 72-74 | QME | Verbatim | |
| 2023-08-01 to 2023-10-10 | Westside Hand Therapy | Therapy series, 12 visits | Right grip 14 kg to 23 kg. Left unchanged at 19 kg. | 80-118 | Staff; QME checked 2024-09-20 | Series | |
| 2023-10-16 | R. Castaneda, MD | PR-2 | Right improved. Left night numbness persists. Full duty from 2023-10-23. | 120-122 | QME | Copy also at 161-163 A5 | |
| 2024-02-05 | R. Castaneda, MD | PR-2 | Left symptoms worse, "drops items." Requests left carpal tunnel release. | 124-127 | QME | ||
| 2024-02-20 | Utilization review | UR decision | Left carpal tunnel release: not certified, "conservative care not documented for the left side since 10/2023." | 62-63 | Staff; QME checked 2024-09-20 | A4 | |
| 2024-06-03 | R. Castaneda, MD | Permanent and stationary report | Declares permanent and stationary. Rates whole person impairment "per AMA Guides, 5th Edition." Future care: left release if symptoms progress. No apportionment stated. | 140-145 | QME | P&S, no apportionment | A6 |
Annotations: why each row reads the way it does
- A1, conditions that may matter for apportionment. Diabetes and hypothyroidism are commonly listed risk factors for carpal tunnel syndrome. Labor Code 4663(c) asks the physician to find what approximate percentage of permanent disability was caused by the work injury and what by other factors. The tag "Other factor to weigh" marks the rows the evaluator will need for that finding. It does not say the factor contributed.
- A2, the first mention, quoted. The earliest note of symptoms, with the patient's own words about the job, matters for when the injury began. It is quoted and its page is exact.
- A3, non-medical records get rows when they set dates. The claim form fixes the claimed period that every other row is read against. It is marked non-medical so nobody mistakes it for a clinical history.
- A4, utilization review rows. Certification and denial decisions explain why the left side was not operated on. Without them, the file reads as if the treating doctor dropped the left wrist.
- A5, second copies are logged, not repeated. The other party served copies of the treating reports at pages 161-201. The row cites the first copy and notes the second, so either party's page numbers lead to the same text.
- A6, quote what the treating report leaves open. "No apportionment stated" is a fact about the record, written as one. It tells the evaluator the issue is open in the file.
Who excerpts the records: the Excerpt column
California Labor Code 4628(a) says that no one other than the physician who signs a medical-legal report may take part in its nonclerical preparation, including "reviewing and summarizing prior medical records." Subdivision (c) allows one route: if the initial excerpting of prior records is not done by the physician, "the physician shall review the excerpts and the entire outline." The statute text was read from the California Legislative Information site on 2026-11-12 (Labor Code 4628).
The Excerpt column turns that into something you can see. Rows drafted by staff say so, with the date the evaluator checked them against the source. Rows the evaluator wrote say "QME". A column like this costs little and answers the question of who did what if it ever comes up. Labor Code 4628(b) also requires the report to disclose the name and qualifications of each person who performed services in connection with it, so the column and the report should agree.
The records-reviewed list and the page count
Under the medical-legal fee schedule, 8 CCR 9795, the ML201 fee, which covers medical-legal evaluations that are not follow-up or supplemental, "includes review of 200 pages of records", pages beyond that are paid at $3.00 per page, and the physician must include "a verification under penalty of perjury of the total number of pages of records reviewed." Read from the DWC regulation text on 2026-11-12.
| Source | Pages | Count |
|---|---|---|
| Claim documents (DWC-1, application, panel request) | 1-11 | 11 |
| Valley Community Clinic, internal medicine, 2019 to 2023 | 12-29 | 18 |
| R. Castaneda, MD, first report and early PR-2 reports | 30-47 | 18 |
| P. Huang, MD, electrodiagnostic study | 48-59 | 12 |
| Utilization review decisions | 60-71 | 12 |
| J. Ortega, MD, hand surgery | 72-79 | 8 |
| Westside Hand Therapy | 80-119 | 40 |
| R. Castaneda, MD, later PR-2 and P&S reports | 120-160 | 41 |
| Second copies of 120-160, served by the other party | 161-201 | 41 |
| Pharmacy records | 202-251 | 50 |
| Employer job description and personnel file | 252-271 | 20 |
| Applicant deposition transcript | 272-389 | 118 |
| Billing records | 390-486 | 97 |
| Total received | 1-486 | 486 |
The sample shows both numbers: 486 pages received, of which 41 are second copies. How second copies count toward the verified total is a question for the fee schedule, the parties and, if disputed, the judge. A sample cannot settle it. What the chronology can do is make both numbers easy to state.
Common misses in QME chronologies
- No record of who excerpted the records, so the 4628 question has no answer in the file.
- Pre-claim conditions left out because they are "not orthopedic".
- Second copies given their own rows, which doubles the treating history.
- UR decisions left out, so gaps in treatment look unexplained.
- A page count assembled after the fact from the cover letters instead of from the file.
Questions about QME chronology samples
Can staff prepare the QME chronology?
Labor Code 4628(c) allows staff to do the initial excerpting only if the physician then reviews the excerpts and the entire outline. Check the current statute and DWC guidance before relying on this sample.
Does the chronology need to show the page count?
The ML201 code asks the physician to verify the total pages reviewed in the report. A records list that ends in a total makes that number easy to state and check.