Table 4 Resource use (costs) to be collected.

Health care provider fees

Initial assessment, follow-up visits.

Fees for completing standardized automobile insurance claims forms

Treatment Plan (OCF-18), Discharge and Status Report (OCF-24).

Health services (block fees)

In-home assessment, functional evaluation, job site assessment, home exercise prescription, multidisciplinary evaluation, workplace/home modification assessment, home exercise prescription, multidisciplinary evaluation, workplace/home/vehicle modification assessment, return to work support, education programs, life skills and job retraining, counseling and coaching, stress management, relaxation therapy, family counseling, cognitive behavioral therapy, pain management.

Patient out-of-pocket expenses

Over-the-counter medications, prescription drugs, portable electrotherapy devices, orthotics, assistive devices, health care supplies, treatment-related expenses.

Diagnostic imaging

Radiography, magnetic resonance imaging, ultrasound.

Benefits

Non-earner, dependent care, caregiver, housekeeping and home maintenance, income replacement, attendant care, lost educational expenses, expense of visitors, long-term care, excess economic loss.

Independent health examination

Chiropractic, medical, occupational therapy, physical therapy, psychological.