Get Printable Doctor Statements

Filling out the Printable Doctor Statements is an essential step in evaluating medical or mental health conditions for individuals seeking assistance from the Department for Children and Families. This guide will help you navigate through the form with ease, ensuring all necessary information is accurately provided.

Follow the steps to complete the Doctor's Statement form online:

1. Click 'Get Form' button to obtain the document and open it in an editing tool of your choice.
2. Begin by entering the name of the individual for whom the evaluation is being completed in the 'Regarding' section.
3. Fill in the individual's Social Security number, birth date, and contact details such as phone and fax under the respective fields.
4. Provide the case name and case number in the specified sections.
5. Evaluate the medical or mental health condition by specifying the diagnosis in 'SECTION ONE'. Ensure to include the diagnosis onset date and anticipated duration.
6. Indicate whether the diagnosis can be controlled by marking the relevant options (medication, surgery, treatment) and provide recovery time if applicable.
7. In 'SECTION TWO', answer whether the diagnosis prevents the individual from engaging in training or work activities, and indicate the duration of such prevention if applicable.
8. If the response to question 5 is 'Yes', skip to 'SECTION FOUR'. Otherwise, proceed to 'SECTION THREE' and answer questions regarding limitations on activities and accommodations needed.
9. Complete the medical provider's signature section in 'SECTION FOUR', ensuring to sign, date, and print the name and title of the medical provider.
10. Once all sections are filled out, save your changes, download the document, print it, or share it as needed.

Complete the form online today to facilitate the assessment process.