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Disability Application Medical Report and Medical Chart

To lower disbursement costs, clinics may ask their clients' doctors to use this medical report or chart instead of requesting a formal medical opinion. Some doctors might be less reluctant to complete these charts than prepare a full medical report. This simplified medical report or chart can be submitted to the Disability Adjudication Unit (DAU) at the Ontario Disability Support Program or Canada Pension Plan to support a client's disability application if additional medical evidence is needed. (Note: The English version was prepared by an unknown clinic. The French version is a translation.)

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English
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Medical report, 1 page
pdf
English
Download the PDF - English
Medical chart, 1 page
pdf
français
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Rapport médical, 1 page
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français
Download the PDF - français
Tableau de rapport médical, 1 page