Activities of Daily Living PEN6234e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
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Amputation of Upper and Lower Limbs PEN6230e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
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Aneurysm and Embolus PEN6240e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
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Ankle Conditions PEN6224e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. Note: Medical questionnaires from Podiatrists are not accepted for ankle conditions. |
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Bruxism, Tooth and Periodontal Conditions PEN6266e | - Dentists (DMD, DDS)
- Dental specialists
|
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Cardiorespiratory Conditions PEN6253e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Cervical Spine Conditions PEN6236e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
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Coccyx, Pelvis and Sacroiliac Joint Conditions PEN6237e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
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Elbow Joint Condition PEN6226e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
|---|
Endocrine and Metabolic Conditions PEN62e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
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Esophageal and Gastroesophageal Junction Conditions PEN6260e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Foot and Toe Conditions PEN6222e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Podiatrists (DPM, Doctor of Podiatric Medicine, DP, Doctor in Podiatry in New Brunswick)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
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Fractures - Lower Limbs PEN6228e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
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Fractures and Miscellaneous Musculoskeletal Conditions of the Chest and Upper Limbs PEN6229e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
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General Medical Questionnaire PEN71e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
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Hearing Loss/Tinnitus PEN6249e | - Audiologists (AuD)
- General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept a hearing instrument practitioner (HIP/RHIP) or a hearing instrument specialists (HIS) if the diagnosis of hearing loss and/or tinnitus was previously provided by an accepted qualified health professionals. |
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Hemopoietic Conditions PEN69e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Hernias and Pilonidal Sinus Disease PEN6255e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
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Hip Conditions PEN6223e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only)
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnosis purposes), we will also accept medical information from physiotherapists. |
|---|
Hypertension PEN6241e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Kidney, Ureter and Bladder Conditions PEN6261e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Knee Conditions PEN6221e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only)
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnosis purposes), we will also accept medical information from physiotherapists. |
|---|
Liver and Gallbladder Conditions PEN6257e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Lower Limb Function PEN6232e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only)
Exception: For assessment/reassessment of a disability only (not for diagnosis purposes), we will also accept medical information from physiotherapists. |
|---|
Malignant Conditions PEN63e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Mandible and Maxilla Conditions PEN6267e | - Dentists (DMD, DDS)
- Dental specialists
- Specialists (MD)
|
|---|
Morbid Obesity PEN6259e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Neurological Conditions PEN56e | - General practitioners (MD, GP, family doctor, medical doctor, physician and sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
|
|---|
Nose, Throat, Sinus Conditions PEN57e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Obstructive Sleep Apnea PEN6251e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Oral Cavity and Salivary Glands Conditions PEN6252e | - Specialists (MD) such as oral & maxillofacial surgeons, otoralyngologists and dental specialists
- Dentists (DMD, DDS)
- General practitioners (MD, GP, family doctor, medical doctor, physician)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Osteomyelitis PEN6231e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Pancreatic Conditions PEN6254e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Peripheral Vascular Arterial Disease PEN6243e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Raynaud's Disease/Phenomenon and Frostbite, Immersion Foot and Other Cold Injuries PEN6242e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Psychiatric/Psychological Condition(s) PEN6248e | - Psychologists: registered (R.Psych), licensed (LP) and associates (PA)
- Psychiatrists (MD)
- General practitioners (MD, GP, family doctor, medical doctor, physician)
- Nurse Practitioners (NP)
- Physician Assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Candidate Registered Psychologists(Psych Cand.Reg.): only if a Registered/Licensed/Associate Psychologist or a Psychiatrist co-signed the medical questionnaire
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept Psychotherapists (RP), Clinical Counsellors (RCC) and Professional Counselors (LPC). Note: Social workers are not accepted health professionals to complete this medical questionnaire. |
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Sexual, Reproductive and Breast Conditions PEN6262e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Shoulder and Acromioclavicular Joint Conditions PEN6220e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnosis purposes), we will also accept medical information from physiotherapists. |
|---|
Skin Diseases and Burn Scars PEN6246e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Small Bowel, Large Bowel, Rectal and Anal Conditions PEN6256e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Stomach and Duodenal Conditions PEN6258e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Superficial Skin Wounds and Scars PEN6245e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Temporomandibular Disorders PEN6268e | - Dentists (DMD, DDS)
- Dental specialists
|
|---|
Thoracolumbar Spine Conditions PEN6235e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
|---|
Thumb/Finger Conditions PEN6227e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
|---|
Upper Limb Function PEN6233e | - General practitioners MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
|---|
Varicose Veins and Deep Vein Thrombosis PEN6244e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Vertigo/Ear Conditions PEN6250e | - General practitioners (MD, GP, family doctor, medical doctor, physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
|
|---|
Visual Conditions PEN6239e | - Ophthalmologists
- Optometrists (OD, Doctor of Optometry): accepted only for visual acuity related conditions and some external disease eye conditions (e.g. conjunctivitis)
|
|---|
Wrist Conditions PEN6225e | - General practitioners (MD, GP, family doctor, medical doctor, physician, sport medicine physician)
- Specialists (MD)
- Nurse practitioners (NP)
- Physician assistants (PA) if practicing in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia or Prince Edward Island only
- Chiropractors (DC, DoC, Doctor in Chiropractic)
Exception: For assessment/reassessment of a disability only (not for diagnostic purposes), we will also accept medical information from physiotherapists. |
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