ASSESSMENT FORMS

FORMS & LINKS

DMI-ATTENDING PHYSICIAN STATEMENT (OLD)

DMI generic APS for for short-term MSK, Mental and other disability cases
No Member Fee

CONTINUING CLAIM FOR SHORT TERM DISABILITY BENEFITS

Continuing claim for short-term disability benefits
No Member Fee

Occupational Fitness Assessment Form

Occupational assessments are associated with employees requiring an accommodation.
No Member Fee

CSSEIP Occupational Fitness Form

CSSEIP Members - Occupational assessments are associated with employees requiring an accommodation.
No Member Fee

Empire Life APS

Empire Life Attending Physician Statement Form
No Member Fee

SSQ Attending Physician Statement MSK

Complete this APS form for new STD applications relating to MSK
No Member Fee

SSQ Attending Physician Statement Mental

Complete this APS form for new STD applications relating to a mental health case.
No Member Fee

CLHIA STD APS

Initial Disability Insurance Medical Statement (Physical + Mental)
No Member Fee

CADA SAW - Cognitive + Functional Abilities Form

Cognitive and functional abilities
No Member Fee

CADA APS (CLHIA)

Attending Physician Statement Forms for CADA
No Member Fee

CADA SAW Cognitive Abilities

CADA SAW Cognitive Abilities
No Member Fee

CADA SAW Functional Abilities

STAY AT WORK - FUNCTIONAL ABILITIES FORM
No Member Fee