Get FL DR-416 2012-2022
PHYSICIAN S CERTIFICATION OF TOTAL AND PERMANENT DISABILITY I Physician s name DR-416 R. 11/12 Rule 12D-16. 002 Florida Administrative Code Effective 11/12 a physician licensed pursuant to Chapter 458 or Chapter 459 Florida Statutes hereby certify that Mr. Miss Ms. Name of totally and permanently disabled person Social Security Number is totally and permanently disabled as of January 1 due to the following mental or physical condition s Quadriplegia Paraplegia Hemiplegia Legal blindness Other to.
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