Sample report

Client

Jordan Sample (fictional)

Reference

IRA-SAMPLE · your file ref EL-0000

Prepared for

Example Lawyers (fictional)

Assessment

Telehealth, Tue 5 May 2026

Clinician

Alex Fictional, physiotherapist (AHPRA PHY0000000000, sample)

Document

Version 1 · ID SAMPLE-0001

Ms Sample has ongoing low back pain after a lifting incident at work. It limits how long she can sit and stand, disturbs her sleep and has stopped some home and leisure activities. A graded exercise and return-to-work program is recommended. Each of your four questions is answered below, under its own number.

• Referral letter and questions, Example Lawyers, 20 April 2026
• GP notes, 4 March to 14 April 2026
• Physiotherapy notes (8 sessions), March to April 2026
• Lumbar spine X-ray report, 10 March 2026

A 75-minute telehealth assessment: history, observed movement tests, and standardised questionnaires completed before the appointment. Telehealth limits some physical tests; where a finding relies on what could be seen by video, this report says so.

1. What injuries does the client report, and what did you find on assessment?

   Ms Sample reports low back pain with pain into the left buttock since a lifting incident at work on 3 March 2026. On assessment, lumbar flexion was limited to about half of the expected range, with pain at the end of range. Straight-leg raise was within normal limits on both sides. Strength and sensation in both legs were normal.

2. How do the injuries affect the client's work, daily activities, sleep and leisure?

   She reports she can sit for about 30 minutes and stand for about 20 minutes before needing to change position, and wakes two to three times a night with pain. She has stopped gardening and needs help with heavy shopping. These reports were consistent with the outcome measures and observations recorded.

3. What treatment has the client had, and what further treatment is reasonably required?

   Eight physiotherapy sessions and a GP review (records listed above). A graded exercise and return-to-work program over 8 to 12 weeks is reasonably required, with review at 6 weeks.

4. What is the likely course of the client's recovery?

   With the program above, improvement is expected over the next three months. Whether she returns to her full pre-injury duties depends on progress at review and is not something this report can determine.

This report is based on the telehealth assessment and the documents listed. Its opinions may change if more information becomes available. It does not include a permanent impairment rating: those are made by approved medical assessors.

Real reports also include the disclaimer for their type and, for reports prepared for legal proceedings, the clinician's acknowledgement of the court's code of conduct. That wording is being settled with our lawyer and isn't shown in this sample.

We provide physiotherapy assessment, rehabilitation planning and clinical reporting. We do not provide legal advice, determine claim entitlement, or guarantee compensation outcomes.