Canada Life uses this two-page statement for the physician's part of an individual critical illness claim on a policy covering a child. It asks for the diagnosis, when symptoms began and what they were, the first consultation, any referral and other physicians or hospitals, with copies of all medical evidence on the investigation, diagnosis and treatment attached.
The physician completes the physician's report and signs section 3. The insured child signs the authorization if over 18, or a parent or guardian signs if the child is under 18, and the claimant completes the critical illness initial claim form (K883 or 186).
Download the current version from the source each time; forms change without notice.
Physician’s initial statement – Child critical illness claim
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.
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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The insured child signs if they are over 18; otherwise a parent or guardian signs. The authorization releases the child's health information to Canada Life for administering the claim and remains in effect for one year from the date it is signed.
The form states that the patient, parent or guardian is responsible for any fees related to its completion and for any other medical information provided. The completed form goes to Canada Life's Living Benefits Claims by mail, email or fax.
Canada Life's individual critical illness claims page says forms must be signed by hand with a pen and that forms with an Adobe signature will not be accepted. The claimant statement can be completed online through DocuSign, but the physician still completes and returns the physician's statement.