Medical Questionnaires

The medical questionnaires have been developed to complement the Table of Disabilities (TOD). Health care providers complete only the medical questionnaire sections relevant to the claimed/entitled condition(s).

The provided medical information represents a composition of the current disability and is utilized, along with other pertinent submitted medical information.

NOTE: Please do not have a medical questionnaire completed until you have been provided with specific instructions from us regarding the questionnaire required. You may also need to complete a consent form that allows us to get your medical information.

Questionnaires

• Activities of Daily Living
• Amputation of Upper and Lower Limbs
• Aneurysm and Embolus
• Ankle Conditions
• Cardiorespiratory Conditions
• Cervical Spine Conditions
• Coccyx, Pelvis and Sacroiliac Joint Conditions
• Dental and Oral Conditions
• Elbow Joint Conditions
• Endocrine and Metabolic Conditions
• Esophageal and Gastroesophageal Junction Conditions
• Foot and Toe Conditions
• Fractures - Lower Limbs
• Fractures and Miscellaneous Musculoskeletal Conditions of the Chest and Upper Limbs
• General Medical Questionnaire
• Hearing Loss/Tinnitus
• Hemopoietic Conditions
• Hernias and Pilonidal Sinus Disease
• Hip Conditions
• Hypertension
• Kidney, Ureter and Bladder Conditions
• Knee Conditions
• Liver and Gallbladder Conditions
• Lower Limb Function
• Malignant Conditions
• Morbid Obesity
• Neurological Conditions
• Nose, Throat, Sinus Conditions
• Obstructive Sleep Apnea
• Oral Cavity and Salivary Glands Conditions
• Osteomyelitis
• Pancreatic Conditions
• Peripheral Vascular Arterial Disease
• Psychiatric/Psychological Condition(s)
• Quality of Life (QOL) Questionnaire
• Raynaud's Disease/Phenomenon and Frostbite, Immersion Foot and Other Cold Injuries
• Sexual, Reproductive and Breast Conditions
• Shoulder and Acromioclavicular Joint Conditions
• Skin Diseases and Burn Scars
• Small Bowel, Large Bowel, Rectal and Anal Conditions
• Stomach and Duodenal Conditions
• Superficial Skin Wounds and Scars
• Thoracolumbar Spine Conditions
• Thumb/Finger Conditions
• Upper Limb Function
• Varicose Veins and Deep Vein Thrombosis
• Vertigo/Ear Conditions
• Visual Conditions
• Wrist Conditions