ACC6272 Pain management plan, review, update and completion report

ACC6272 Pain management plan, review, update and completion report Complete this form to let us know about this client's pain management plan, their progress and your final completion report. You can use the following table to determine which sections to complete and indicate which report you're submitting back to us. If you're reporting on the…then complete…and check the relevant box:initial interdisciplinary team meeting and Client care planParts A, B and C[x]subsequent interdisciplinary team meeting and/or care plan updatesPart C and D[ ]service completionPart E[ ] After each update, return the updated form to the ACC contact email address in Part A, Section 3. below. Part A – Key contact details 1. Client details Client name: James O'Connor ACC claim number: 10045678 2. Vendor details Vendor name: Wellington Pain Management Centre Vendor ID number: PMC4521 Name of Key worker: Dr Hannah Chen Key worker phone: 04 938 7421 Key worker email: h.chen@wpmc.co.nz 3. ACC contact details Does the client have a Recovery Team Member? [x] Yes [ ] No (If yes please provide details below) ACC Recovery Team Member: Marcus Tan ACC contact phone number: 0800 101 996 ACC contact email address: marcus.tan@acc.co.nz Part B – Initial assessment 4. Initial interdisciplinary team meeting Please provide your interdisciplinary team meeting minutes, summarising your assessment of this client. Refer to the Pain Management Operational Guidelines for instructions on what to include in this section. Please list the members of the interdisciplinary team and their profession. James is a 42 year old warehouse worker who sustained a lower back injury in November 2024 lifting a 25 kg box at work. He reported immediate lower back pain radiating into the right leg. Initial diagnosis was acute lumbar strain; MRI six weeks post-injury confirmed an L4-L5 disc protrusion with right L5 nerve root impingement. He completed 12 weeks of community physiotherapy and a course of oral analgesia with no functional improvement, and was referred to pain management services four months post-injury. James has been off work continuously since the injury (14 months at the time of assessment). The interdisciplinary team has assessed James as having moderate to severe chronic pain with significant biopsychosocial complexity. Key findings include entrenched fear-avoidance behaviours, pain catastrophising (PCS score 38), low self-efficacy, deconditioning, sleep disturbance, and reduced social engagement. James remains motivated to return to work and reports good family support. He is assessed as suitable for a 12 week functional restoration programme at Community Service Level Two. Dr Hannah Chen, Clinical Psychologist (Key worker) Sarah Mitchell, Physiotherapist Tom Williams, Occupational Therapist Dr Priya Sharma, Pain Medicine Specialist Dr Liam Brennan, General Practitioner 5. Confirmation of suitability for pain management service Is the client under the correct Pain Management service level? [x] Yes [ ] No, please indicate which service level you recommend instead: [ ] Community Service Level One [ ] Community Service Level Two [ ] Tertiary services [ ] Group education [ ] No, the client is not suitable for Pain Management services: Please explain why any recommended change is needed: 6. Duration of service Recommended number of weeks: 12 Proposed start date: 03/06/2026 Next interdisciplinary team meeting or review date: 17/07/2026 Proposed end date: 26/08/2026 7. Who will be involved in delivering the service? Please list the details of each provider that will be involved in this service. Names of providerProfessional scopeSarah MitchellPhysiotherapistTom WilliamsOccupational TherapistDr Hannah ChenClinical PsychologistDr Priya SharmaPain Medicine Specialist Part C – Client Care Plan 8. Plan, Progress and Completion Describe the client's rehabilitation goalHow will this be achieved?Who is responsible?Increase walking tolerance from 10 minutes to 30 minutes (Goal date: 26/08/2026). Functional.Graded exercise programme with physiotherapy 2/week; daily home walking programme; pacing strategies within a functional restoration framework.Sarah Mitchell, Physiotherapist (PT)Return to modified duties at 4 hours per day, 3 days per week (Goal date: 26/08/2026). Functional and vocational.Vocational rehabilitation with occupational therapy 1/week; graded return to work plan negotiated with employer; ergonomic workplace assessment within the first 4 weeks.Tom Williams, Occupational Therapist (OT)Reduce Pain Catastrophising Scale score from 38 to below 20 (Goal date: 26/08/2026). Psychological.Cognitive behavioural therapy (CBT) 1/week targeting pain-related cognitions and fear-avoidance; pain education group 1 session.Dr Hannah Chen, Clinical PsychologistResume social engagement with family and community at minimum 1 outing per week (Goal date: 26/08/2026). Social.Activity scheduling and behavioural activation within CBT sessions; joint goal-setting with occupational therapy around community-based functional activities.Dr Hannah Chen (Psychologist) and Tom Williams (OT) General Comments: James presents with strong insight, appropriate motivation, and is engaged with the rehabilitation approach. Main barriers are entrenched fear-avoidance behaviours and 14 months of activity restriction. The team anticipates measurable functional gains within the 12 week programme. Goals will be formally reviewed at the 6 week interdisciplinary team meeting on 17/07/2026; revisions to goal dates will be documented at that point if required. Part D – Service updates 9. Subsequent interdisciplinary team meeting and/or care plan updates Part E – Completion report 10. Completion report recommendations 11. Declaration and signature As the Keyworker and a member of the interdisciplinary team, I certify that I have personally examined and/or treated the client discussed their treatment options with them and advised why the recommended intervention(s) are appropriate in this case. The client (or their representative) has authorised me to provide this information to ACC. Key worker name: Dr Hannah Chen Signature: Date: 02/06/2026 When we collect, use and store information, we comply with the Privacy Act 2020 and the Health Information Privacy Code 2020. For further details see ACC's privacy policy, available at www.acc.co.nz. We use the information collected on this form to fulfil the requirements of the Accident Compensation Act 2001. Items for Clinician Review Section 6, Proposed start date: stated verbally as "first week of June" rather than an explicit date; verify 03/06/2026 with the team before submission. Section 8, Pain Catastrophising Scale baseline: PCS total of 38 was given verbally; confirm this is the most recent validated PCS-13 score and not an earlier reading.