Part B - Medical practitioner's section
Page 3 sets the test you are reporting against. A marked restriction means that, even with appropriate therapy, devices and medication, the patient is unable, or takes an inordinate amount of time, in one category all or substantially all of the time, which the CRA generally interprets as 90% or more. Compare the patient with someone of similar age without the impairment. Fill out only the categories that apply, and if you run out of space, attach a signed sheet with the patient's name at the top of every page.
Vision
Initial your designation (medical doctor, nurse practitioner or optometrist) and list the conditions with the year of diagnosis. Record visual acuity for each eye after correction, either on the Snellen chart or as count fingers, no light perception, light perception or hand motion, and the greatest diameter of the field of vision in degrees. The key question is whether, in both eyes, acuity is 20/200 (6/60) or less or the field is 20 degrees or less. Then give the year of onset, whether it has lasted or will last 12 continuous months, and whether it is likely to improve.
Speaking and Hearing
Both pages measure function with a familiar person in a quiet setting. Speaking can be certified by a medical doctor, nurse practitioner or speech-language pathologist; hearing by a medical doctor, nurse practitioner or audiologist. The hearing page also asks for the level of loss in each ear, from normal (0 to 25 dB) to profound (91 dB or more). Examples are mandatory, such as needing repetition, extra time for word retrieval, lip-reading or sign language. Then say whether the patient is unable, or takes at least three times longer than someone of similar age, all or substantially all of the time.
Walking
A medical doctor, nurse practitioner, occupational therapist or physiotherapist can complete this page. List conditions, medication, and devices or therapy such as a cane, then give mandatory examples of how walking is impaired despite them: needing assistance, impaired balance, or frequent breaks because of pain or shortness of breath. The reference task is a short distance such as 100 metres. Say whether the patient is unable, or takes at least three times longer than someone of similar age, all or substantially all of the time.
Eliminating
Only a medical doctor or nurse practitioner can certify this category, which covers the patient's ability to personally manage bowel or bladder functions. Note devices or therapy such as an ostomy, then give mandatory examples: needing another person's help, relying on enemas for chronic constipation, wearing incontinence briefs, or requiring intermittent catheterization. Then answer the inordinate-time question (at least three times longer), the all-or-substantially-all question, the year of onset, the 12-month duration and the likelihood of improvement.
Feeding and Dressing
A medical doctor, nurse practitioner or occupational therapist can complete either page. Feeding includes preparing food, except time spent on a dietary restriction or regime, but not identifying, finding, shopping for or obtaining food; examples include being unable to hold utensils, relying exclusively on tube feeding, or needing help to prepare meals. Dressing excludes identifying, shopping for or obtaining clothing; examples include upper-extremity pain, limited range of motion or needing help to dress. Both pages then ask the same timing, onset and duration questions.
Mental functions necessary for everyday life
A medical doctor, nurse practitioner or psychologist completes these three pages. Page 11 covers conditions, medication and how effective it is, whether the patient needs reminders to take it, devices or therapy, and whether they can live independently (or, for a child, function at home or school) without daily supervision or support. Page 12 rates no, some or severe limitations in adaptive functioning, attention, concentration, goal-setting, judgment, memory, perception of reality, problem-solving, regulation of behaviour and emotions, and comprehension. Page 13 asks for examples, especially where you ticked some limitations.
Cumulative effect of significant limitations
Use this page when no single category meets the marked-restriction test but the patient has significant limitations in two or more. A medical doctor or nurse practitioner can complete it; an occupational therapist only for walking, feeding and dressing. Select the categories, give mandatory examples, and confirm that the limitations exist together all or substantially all of the time, meaning during the same period even if the activities don't happen at once, and that their combined effect equals being unable, or taking an inordinate amount of time, in one category.
Life-sustaining therapy
Only a medical doctor or nurse practitioner can certify this category. Type 1 diabetes diagnosed in 2021 or later needs only the year of diagnosis. Otherwise, the therapy must support a vital function, be needed at least 2 times a week (3 for years before 2021), and take an average of at least 14 hours a week that the patient or another person dedicates to it. Count dose adjustment, therapy logs, required medical food or formula regimes, receiving therapy and equipment set-up, but not exercise, travel, obtaining medication or a device's delivery time.
Certification (mandatory)
Every Part B needs this page. Give the years the person has been your patient and whether you have medical information on file for all the years you certified, tick one practitioner type, then sign, print your name and add your telephone number, date and address; the licence or registration number is optional. On paper, the CRA can't process Part B if it is unsigned or the signature is not handwritten. The form warns that it is a serious offence to make a false statement.