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
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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.
|
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
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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.
|
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
|
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
|
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
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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
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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
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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).
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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
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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
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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
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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
- Chiropractors (DC, DoC, Doctor in Chiropractic)
|
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
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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.
|