• When you arrive at your appointment location, please check in with a member of staff.
• The interpreter, when needed, will meet you at the time of check-in.
• You will then be instructed to fill out the necessary medical history questionnaire, and other paperwork.

• A Telemedicine Independent Medical Exam (T-IME) takes place at a partnering physical therapy clinic with an expert medical professional – typically a physical therapist (PT) or occupational therapist (OT).
• When you arrive at the assigned physical therapy clinic, please check in with a member of staff.
• The interpreter, when needed, will meet you at the time of check-in.
• You will then be instructed to fill out the necessary medical history questionnaire before entering the exam room with the in-person PT or OT.
• The doctor will join the exam virtually using a high-resolution camera and speakerphone system.

• It is important to understand that in your exam, you will not be receiving treatment for your condition or injury.
• Only you, the physician, the physician’s assistant, and the interpreter, if needed, will be present during the exam.
• Be prepared to discuss your medical history questionnaire with the physician.
• Your exam may include measurements, and assessments relevant to the injury or condition in question.
• The physician will thoroughly evaluate your medical status and may ask you questions about your symptoms, medical history, how the injury occurred, and how it may be affecting your daily life.
• The physician may also document their findings through written notes.

• The physician may discuss their preliminary findings with you and provide you an opportunity to ask them questions or provide further information.
• From the medical records received and reviewed, and the examination, the physician will submit a report detailing their assessment and conclusions to the party that requested the examination; your injury representative.
• It is important to understand that all communication between Merit Medical Evaluations and yourself, whether before or after your exam, must be done through your injury representative; the person or entity that requested the exam.
• You are entitled to copies of information surrounding your appointment. Merit Medical Evaluations will provide you, upon your request, with a copy of any form that you sign during your appointment.
• You are also entitled to a copy of the doctor’s detailed report. However, a copy of the report must be requested by you from your injury representative, not directly from Merit Medical Evaluations.

Nebraska

Jacobsen Therapy Services
2108 Taylor Ave.
Norfolk, NE 68701

Merit Medical Evaluations
12103 Anne St.
Omaha, NE 68137

Morrill County Community Hospital
1313 S St.
Bridgeport, NE 69336

Sandhills Physical Therapy and Sports Rehab
624 West Leota St.
North Platte, NE 69101

Missouri

SERC Physical Therapy
334 E Mt. Vernon Blvd
Mount Vernon, MO 65712

SERC Physical Therapy
3727 Gene Field Rd.
Saint Joseph, MO 64506