(b) Reports of second opinion physicians and agreed second opinion physicians shall include, where applicable:
(1) The date of the examination;
(2) The patient's complaints;
(3) A listing of all information received from the parties reviewed in preparation of the report or relied upon for the formulation of the physician's opinion;
(4) The patient's medical history relevant to the treatment determination;
(5) Findings on record review or examination;
(6) The relevant diagnosis;
(7) The physician's opinion whether or not the proposed spinal surgery is appropriate or indicated, and any alternate treatment recommendations;
(8) The reasons for the opinion, including a reference to any treatment guidelines referred to or relied upon in assessing the proposed medical care;
(9) The signature of the physician.
(c) Second opinion physicians and agreed second opinion physicians shall serve with each report the following executed declaration made under penalty of perjury:
In connection with the preparation and submission of the attached report
of second opinion on recommended spinal surgery, I declare, on the date next written,
under penalty of perjury of the laws of the State of California, that I have no
material familial affiliation, material financial affiliation, or material professional
affiliation prohibited by Labor Code Section 4062, subdivision (c).
Authority cited: Sections 133 and 5307.3, Labor Code. Reference: Sections 4062(b) and 4600, Labor Code.
1. New section filed 7-2-2004 as an emergency; operative 7-2-2004 (Register 2004, No. 27). A Certificate of Compliance must be transmitted to OAL by 11-1-2004 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 7-2-2004 order transmitted to OAL 11-1-2004
and filed 12-15-2004 (Register 2004, No. 51).
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