Answer:
*Relevant medical history, past history, social history, and family history
*Dates patient became disabled
*Subjective symptoms/complaints (patient's words)
*Objective findings on physical examination (example physical/mental status exam results, contusions, blood pressure)
*Severity of the illness/injury
*Laboratory and x-ray studies/findings, hospital discharge reports
*Diagnostic studies
*Diagnosis
*Medication
*Treatment prescribed/dates with patient's response and prognosis
*Medical prognosis (outcome of disease/injury based on medical findings)
*Names of any other treating physicians
*Date patient expected return to work
*Description of job duties and patient's ability to perform work
Step-by-step explanation: