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BC Form HR3103: Medical Report for a Child

When a parent on B.C. income assistance seeks an exemption from employment obligations or an earned income exemption because of a child's physical or mental condition, a physician uses this one-page report to describe the child's condition, prognosis and care needs. The ministry uses it to assess the parent's employability, and the report is shared with the recipient and with the appeal tribunal if there is an appeal.

Who completes it

A physician registered with the College of Physicians and Surgeons of BC completes Part C: conditions, severity, prognosis, episodic pattern, weekly care and supervision required, and certification. The parent or guardian signs Part B, the authority to release information, with a witness.

Submitting and payment

How to submit it
The ministry issues the form to the parent under a Service Request number, and the completed report goes back to the ministry for its employability assessment.
Who pays
The physician may bill the fee for completing the form through MSP under fee item 96505.

Good to know

  • All questions must be answered completely; the form warns that incomplete information may mean the parent or caregiver is not accurately assessed.
  • Part C asks for primary and secondary conditions, overall severity (mild, moderate or severe), expected duration, whether the condition is episodic and how often episodes recur.
  • The physician describes, qualitatively and quantitatively, the help or supervision the child needs in a typical week, such as personal care, mobility or giving medications.
  • The exemption for a sole recipient caring for a child does not apply to two-parent families where only one parent is prevented from leaving home for work.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Report – Child

Official pagePDF

Fill it with Vero

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How this list is checked

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.

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Frequently asked questions

Who can complete BC form HR3103?

A physician registered with the College of Physicians and Surgeons of British Columbia and licensed to practise clinical medicine in B.C., either a general practitioner or a specialist. The physician states how long they have been the child's practitioner and, if 6 months or less, whether they reviewed previous medical records.

Is the child's medical report confidential?

The contents are confidential but are shared with the recipient and, if an appeal is started, with the Employment and Assistance Appeal Tribunal. The parent or guardian signs consent allowing the physician to disclose the child's medical information to the ministry.