3sHealth DIP Attending Physician's Initial Statement

Saskatchewan health-care employees applying to a Disability Income Plan administered by 3sHealth (CUPE, General, SEIU-West and SUN plans) need this statement with their employee and employer application forms. It is the CLHIA Initial Disability Insurance Medical Statement in 3sHealth branding, and 3sHealth notes that a doctor's note alone is not sufficient to support a disability application.

Who completes it

A licensed physician or nurse practitioner involved in the patient's care completes Section 2; a chiropractor or registered psychologist may complete it for up to eight weeks from the disability start date. The employee completes Section 1, and the employer and employee each complete their own initial application form.

Submitting and payment

How to submit it
Applications can be mailed, emailed, faxed or dropped off in person, and all forms must be signed and dated to be processed. The fillable PDF can be completed, signed, scanned and emailed.
Who pays
The employee pays for the initial statement; once a long-term disability claim is approved, 3sHealth pays a standard fee for medical forms it requests.

Good to know

  • 3sHealth's consulting physician asks that the form be completed in keeping with the College of Physicians and Surgeons of Saskatchewan policy on certifying illness and assessing capacity for work.
  • The statement should cover the disabling diagnosis, co-morbid conditions affecting recovery, subjective symptoms, objective findings, the treatment plan and the patient's work restrictions and limitations, documented fully and legibly.
  • If the patient has returned to work or the disability will last less than 4 weeks, the form says to stop after the surgery questions and sign; otherwise complete all pages.
  • 3sHealth notes the statement can be downloaded within the Accuro and Med Access electronic medical records.

Get the official form

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

Attending Physician's Initial Statement Form

Fill it with Vero

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.

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Can a chiropractor or psychologist complete the 3sHealth physician's initial statement?

Yes, for a limited time. 3sHealth allows a chiropractor or registered psychologist to complete the statement for up to eight weeks from the disability start date. After that, a licensed physician or nurse practitioner must complete any further medical forms supporting the Disability Income Plan claim.

Who pays for the 3sHealth Attending Physician's Initial Statement?

The employee. Under the plan, it is the applicant's responsibility to provide medical information supporting the application, and 3sHealth says this obligation was agreed by a wide group of stakeholders, including employee representatives. Once a long-term disability claim is approved, 3sHealth pays a standard fee for medical forms it requests.

Is a doctor's note enough for a 3sHealth disability application?

No. 3sHealth states that a doctor's note is not sufficient to support an application for disability benefits. The employee must provide medical evidence that clearly shows they are totally disabled, and 3sHealth's medical consultants check that the reported diagnosis, treatment plan and prognosis fit the objective information.