3. Complete Health Status Report and Activities of Daily Living Index

The 2 forms in the that health professionals fill out are the Health Status Report and the Activities of Daily Living Index.

The Health Status Report

This must be filled out by one of the following “approved health professionals”:

  • a family doctor or a specialist
  • a psychologist or a psychological associate
  • an optometrist
  • a registered nurse or a nurse practitioner

In the Health Status Report, your approved health professional confirms that:

  • you have one or more substantial physical or mental health problems
  • your health problems are expected to last at least one year
  • your health problems substantially limit your ability to work, look after yourself, or take part in activities at home or in the community

The Activities of Daily Living Index

This must be filled out by one of the following “approved health professionals”:

  • a family doctor or a specialist
  • a psychologist or a psychological associate
  • an optometrist
  • an audiologist or a speech language pathologist
  • an occupational therapist or a physiotherapist
  • a chiropractor
  • a social worker
  • a registered nurse or a nurse practitioner

In the Activities of Daily Living Index, your health professional states how much your health problem limits your ability to:

  • work
  • look after yourself
  • take part in activities at home and in the community

The Activities of Daily Living Index does not have to be filled out by the same health professional who fills out the Health Status Report.

For example, your family doctor may be the best person to fill out the Health Status Report. And your occupational therapist may be the best person to fill out the Activities of Daily Living Index.

Talking to your health professional

It's a good idea to make an appointment so you can talk to your health professional before or while they fill out the forms. That way, you can answer any questions they have.

It's important that they know about all of your health problems and all of the ways those problems affect you.

If you made notes about your health problems, you may want to give these to your health professional. And if you completed the Self Report, give your health professional a copy of this as well.

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