This index shows the Disability Adjudication Unit how an ODSP applicant's impairments restrict their ability to work, look after themselves and take part in home and community life, one of the tests in the program's definition of disability. You rate 26 routine activities, explain limitations against the conditions listed on the Health Status Report, and describe the aids and supports needed. Adjudication waits until both forms are submitted.
Any professional approved for the Health Status Report (physician, nurse practitioner, registered nurse, psychologist, psychological associate or optometrist) can complete it, as can a chiropractor, physiotherapist, occupational therapist, social worker, audiologist or speech-language pathologist. If a different professional completes the HSR, each signs only their own part, and the patient completes the consent form and optional Self Report.
Section 8 rates the patient's limitations in routine daily activities, showing the direct impact of the conditions listed in Section 1 of the Health Status Report. Explain how the impairments and restrictions limit the person's ability to work, look after themselves and take part in activities at home and in the community. You don't need a new assessment: use information already in the patient's file. The patient's member ID appears on each page of the form.
Rate all 26 activities in Section 8.1. DK means don't know; 0 is no limitation (the task is completed fully without help); 1 is mild (minor help or extra time); 2 is moderate (support and some supervision needed); 3 is severe (the patient cannot do the task at all and someone else does it). Where needed, add a comment describing the limitation. The guide's sample rates dressing and meal preparation at 2 and selecting clothes for the weather at 1, each with a short explanation.
Describe any aids, services, supports or help the patient needs: assistive devices or equipment such as a cane, wheelchair or CPAP, service or guide animals, and support services or resources such as case management, developmental services or personal support workers. The completion checklist also lists Sections 8.2 and 8.3 as mandatory, so check that neither is left blank before you submit or sign.
On paper, sign and date Section 9 if you completed the ADLI alone or both the ADLI and the HSR, adding your name, profession, regulatory college, registration number and practice location. Unsigned paper applications are not accepted and are returned, delaying the decision. Online submissions skip Sections 7 and 9: your secure login supplies your details and accepting the terms replaces the signature.
Download the current version from the source each time; forms change without notice.
Activities of Daily Living Index (ADLI) - ODSP Disability Determination Package
ODSP (MCCSS) - Disability Adjudication Unit takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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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Physicians, nurse practitioners, registered nurses, psychologists, psychological associates and optometrists, plus chiropractors, physiotherapists, occupational therapists, social workers, audiologists and speech-language pathologists. The last six can complete only the ADLI, not the Health Status Report. Each must be a member of their Ontario regulatory college and signs only the part they completed.
Each of the 26 activities gets DK (don't know), 0 (no limitation: completes the task fully without help), 1 (mild: minor help or extra time), 2 (moderate: needs support and some supervision) or 3 (severe: cannot do the task at all, someone else does it). Where needed, describe the limitation and link it to the conditions and impairments in HSR Section 1.
Yes. One professional can complete both forms, or two can each complete one, for example a physician on the Health Status Report and an occupational therapist on the ADLI. Each signs the part they completed; on paper, the ADLI is certified in Section 9. The package is adjudicated only after both forms are completed and submitted.
Physicians bill OHIP directly: K052 for the ADLI alone, or K050 if they also complete the Health Status Report. Other professionals invoice the ministry, listing their full name, profession and contact details, the patient's full name, date of birth and social assistance member ID, and the section completed.