Service Canada needs this report from a treating doctor or nurse practitioner to decide a Canada Pension Plan disability application for a severe and prolonged, non-terminal disability. It asks for conditions, functional limitations, treatment, prognosis and work capacity. Service Canada weighs your findings with the patient's age, education and work experience to decide whether the disability regularly prevents any substantially gainful work.
The applicant fills out Section 1 and signs the Section 2 consent, writing their SIN at the top of each page. The doctor or nurse practitioner completes Sections 3 to 9, signs the declaration and sends the report to Service Canada.
The applicant completes these before giving you the report. Check that Section 2 has one consent option chosen and is signed, because the consent must be returned with the report and a missing choice can delay processing. You may photocopy the consent for your records but send the original; if you need an original signature, the stand-alone consent form is ISP-2502. The signed consent is valid for up to 5 years.
Tick how long the patient has been in your care (1 year or less, 1 to 2 years, 3 to 4 years, or 5 years or more), then give the number of visits in the past 12 months, the date of the last visit and the date you started treating the primary condition. Service Canada uses this to confirm it has the patient's complete medical history. If the patient did not apply when first disabled, it may ask for information going back several years.
Complete this only for a terminal illness or one of the 41 grave conditions in Annex A; otherwise skip to Section 5 without removing the page. For a terminal illness (not curable or adequately treatable and reasonably expected to cause death within 6 months), give the diagnosis, ICD-9-CM code and symptom onset, then describe any other disabling conditions in Section 5 or skip to Section 6. For a grave condition, tick yes and describe it in Section 5.
Use one page per condition, listed in order of greatest functional impact, and record height and weight. For each, give the condition, ICD-9-CM code (XXX.X), symptom onset, the impairments and the functional limitations, for example being unable to sit, stand or walk for more than 20 minutes. Rate prognosis, expected duration and frequency, explaining any unknown in Section 7. List medications and other treatments with start and end dates and the response, including side effects. Annexes B and C give worked examples.
Say whether you recommended that the patient stop working, and from what date, or whether it was not discussed. If the condition is terminal, skip the rest. Otherwise state, from a strictly medical standpoint, whether you expect a return to any type of work. If yes, give the time frame (6 to 12 months, 12 to 24 months, more than 24 months or unknown) and whether you expect usual work, modified work, or another type of work that will require training.
Add anything that helps Service Canada judge the applicant's current and future ability to work: planned investigations, pending specialist consultations, and the reason a prognosis or frequency is unknown. Service Canada also lists the impact on the patient's ability to work now and in the future, and the psychosocial impacts of the disability on work, among the information you may need to provide, so add that context here if the condition pages don't capture it.
Tick the reports you are attaching for the conditions in Sections 4 and 5: longitudinal clinical notes, medical investigation reports, specialist reports, hospital discharge reports or other. Send copies of relevant reports, not the patient's entire medical file. The examples in Annex C point to attached imaging, surgical and psychiatrist reports to support the impairments listed.
Confirm that the information is accurate and complete to the best of your knowledge, then identify yourself as a general practice physician or physician certified in family medicine (CCFP), another physician specialist, a nurse practitioner, or a registered nurse in a geographically isolated community. Sign and date the report and print or stamp your name, address and telephone number. Return all 10 pages of the report itself; only the annexes come off before mailing.
Download the current version from the source each time; forms change without notice.
Medical Report for Canada Pension Plan Disability Benefits
Rapport médical pour prestations d'invalidité du Régime de pensions du Canada
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Sources for this guide
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Sections 3 to 9 must be completed by a doctor or nurse practitioner. The Section 9 declaration lets you identify as a general practice or family physician (CCFP), another physician specialist, a nurse practitioner, or a registered nurse in a geographically isolated community. The applicant completes Sections 1 and 2 before giving you the report.
Yes. Service Canada pays the doctor or nurse practitioner directly, up to a maximum set on its medical professionals page, and the patient pays anything above that. Mail your invoice to the Service Canada office listed on the form with the patient's name, address and identification number, plus your business number, GST/HST number or SIN, or it can't be processed.
Yes, for patients you follow closely and for whom you keep detailed notes. The notes must answer all of the report's questions, and you still complete Section 5 (conditions, impairments, functional limitations and treatment) and the Section 9 declaration. You do not need to send the patient's entire medical file.
Section 4 flags terminal illness, defined as a disease that can't be cured or adequately treated and is reasonably expected to cause death within 6 months, and the 41 grave conditions in Annex A, such as ALS, pancreatic cancer and early-onset Alzheimer's disease. With a complete application, Service Canada aims to decide within 5 business days for terminal illness and 30 calendar days for grave conditions.