The Disability Adjudication Unit uses this report to decide whether an Ontario Disability Support Program applicant meets the program's definition of a person with a disability, and it does not assess the patient in person. Patients bring it to you in the Disability Determination Package, or you open it online in SADIE. You record each condition with its impairments, restrictions, prognosis and duration, plus treatment and supporting reports.
A physician, nurse practitioner, registered nurse, psychologist, psychological associate or optometrist who is a member of their Ontario regulatory college completes the whole HSR. You or another approved professional completes the Activities of Daily Living Index, and the patient completes the consent form and, if they choose, a Self Report.
Fill in or confirm the patient's name, date of birth and address, plus the 9-digit Member ID and 12-digit Referral ID printed in the top right corner of the package. You or the patient can provide these details. The same two numbers open the patient's package online in SADIE, and the member ID also goes on any invoice a non-physician sends the ministry.
List each medical condition separately, with its resulting impairments, restrictions or limitations, prognosis and duration. The prognosis options are improve, remain the same, deteriorate or unknown. For duration, state whether it is expected to last less than 1 year or 1 year or more, and whether it is continuous or recurrent/episodic. The guide's sample lists chronic back pain as deteriorating, 1 year or more, continuous. Every element is mandatory, and one gap makes the HSR incomplete.
Complete this when Section 1 includes a mental health condition, a substance-related or addictive disorder, a neurodevelopmental disorder, or another condition presenting with a mental or cognitive impairment. Attach relevant reports, such as psychology, psychiatry, neuropsychological or mental health consult reports, educational assessments or individual education plans, or describe the condition. Section 2.1 has four Yes/No questions, and the checklist requires an answer to each.
The IEWS is a checklist of features or symptoms seen in mental health, substance use, neurocognitive and related conditions that affect daily functioning. It is required whenever Section 1 lists a condition or impairment of that kind. Rate every one of the 28 symptoms in Section 2.2 as DK (don't know), 0 (not present), 1 (mild), 2 (moderate) or 3 (severe); the checklist requires all 28 to be rated.
Describe relevant findings, or attach reports from other professionals' consultations and assessments, such as diagnostic tests, specialist consults and vocational or occupational therapy reports. The completion checklist requires Sections 3.1 and 3.2. Online, each attachment can be up to 10 MB in DOCX, DOC, RTF, TIFF, TIF, PDF or GIF format, with no limit on the number of files. Include only reports relevant to the conditions on the HSR.
Complete Section 4 only when Section 1 identifies a visual condition or impairment, and Section 5 only when it identifies an auditory condition or impairment. In either case, attach the relevant reports. Optometrists are among the professionals approved to complete the whole HSR, not just the Activities of Daily Living Index.
Describe treatment for the Section 1 conditions and the patient's progress. If pharmacotherapy is used, list the conditions or impairments it treats. For admissions, emergency visits or surgery, give the purpose or attach admission and discharge reports. Describe the response to services such as addiction services, counselling, psychotherapy, physiotherapy, occupational therapy, chemotherapy, radiation, vocational rehabilitation or an Indigenous Healer. Note past treatment and why it stopped, and say so if there is none.
On paper only, sign and date Section 7 if you completed the HSR alone, adding your name, profession, regulatory college, registration number and practice location. If you also completed the Activities of Daily Living Index, sign Section 9 instead. Unsigned paper forms are not accepted and are returned. Online, SADIE needs no signature: your secure login supplies your details and accepting the terms takes its place.
Download the current version from the source each time; forms change without notice.
Health Status Report (HSR) - 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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A physician, nurse practitioner, registered nurse, psychologist, psychological associate or optometrist registered with their Ontario regulatory college. Chiropractors, physiotherapists, occupational therapists, social workers, audiologists and speech-language pathologists can complete only the Activities of Daily Living Index. One professional can complete both forms, or two can each complete one and sign their own part.
No. The ODSP guide says you don't have to do a new assessment, investigations or consultations. Report what is already in the patient's file and attach the relevant clinical notes, hospital reports, consult reports or test results that support the conditions in Section 1. You don't need to send the whole medical record.
Yes, through SADIE, which needs an OHIP billing number and an Ontario government secure login (OPS BPS Secure, called GO Secure in the ODSP guide). You open the package with the patient's Member ID and Referral ID, can save and return later, and the smart form flags missing mandatory items. Delegates can submit for you; designates prepare forms for you to submit.
90 calendar days. If more time is needed, the patient contacts the Disability Adjudication Unit to ask for an extension. After submission, the unit may send you an Additional Medical Information request, due within 45 days. Unsigned paper forms are returned and incomplete ones may be, which delays the decision.