CASE MANAGER: FORMS & LINKS
Private ER (No member fees)
Use this form for CLHIA assessments. There is no fee for the member.
No Member Fee
Occupational Fitness Assessment Form
Occupational assessments are associated with employees requiring an accommodation.
No Member Fee - CSBTNo Member Fee - Op ExpensesNo Member Fee - Private ER
CSSEIP Occupational Fitness Form
CSSEIP Members - Occupational assessments are associated with employees requiring an accommodation.
No Member Fee - CSBTNo Member Fee - Ops ExpensesNo Member Fee - Private ER
SSQ Attending Physician Statement MSK
Complete this APS form for new STD applications relating to MSK
$129 if Member Paid
CONTINUING CLAIM FOR SHORT TERM DISABILITY BENEFITS
Continuing claim for short-term disability benefits
$129 if Member PaidNo Member Fee
SSQ Attending Physician Statement Mental
Complete this APS form for new STD applications relating to a mental health case.
$129 if Member Paid
DMI-ATTENDING PHYSICIAN STATEMENT (OLD)
DMI generic APS for for short-term MSK, Mental and other disability cases
$129 if Member Paid