Industry initial medical statement used for Saskatchewan Blue Cross disability claims.
- Completed by
- Attending physician or other medical provider
- Issued by
- Saskatchewan Blue Cross
- Format
- Language
- English
Saskatchewan Blue Cross DISB-1010 Critical Illness APS
Saskatchewan Blue Cross uses this two-page attending physician's statement to assess a critical illness benefit claim, whether filed on the individual application (DISB-1023) or the group application (DISB-1016). The physician gives the diagnosis, onset and first treatment dates, hospital and surgical treatment, other treating physicians, the effect on activities of daily living and a prognosis, and encloses the supporting test results.
Who completes it
The attending physician completes the Attending Physician's Statement on both pages and signs it with their specialty, address, phone and fax numbers. The patient signs the Patient Authorization at the top, and the claimant completes the separate critical illness benefit application.
Submitting and payment
- How to submit it
- Saskatchewan Blue Cross's forms page presents its claim forms for submission by mail, and the statement carries the insurer's Saskatoon mailing address at the top.
Good to know
- Enclose copies of all relevant test results, including lab work, stress tests, angiogram, ECG and MRI, plus pathology reports, hospital records and consultation reports.
- The patient's authorization excludes genetic test results from the medical and health information released to Saskatchewan Blue Cross and Blue Cross Life Insurance Company of Canada.
- List other physicians treating the condition, the family doctor and specialists, with their contact details, and give the outpatient, inpatient admission and discharge dates for any hospital treatment.
- Page 2 asks how eating, dressing, bathing, ambulation and toileting are affected by the condition, followed by your prognosis and any other information to assist the review.
Get the official form
Download the current version from the source each time; forms change without notice.
Attending Physician's Statement Form (Critical Illness)
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.
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Frequently asked questions
What is Saskatchewan Blue Cross form DISB-1010?
It is the Attending Physician's Statement for a critical illness benefit claim, current edition DISB 1010 (02/25). Saskatchewan Blue Cross lists it under Critical Illness Claims with the individual Application for Critical Condition Benefits (DISB-1023) and the Application for Group Critical Condition Benefits (DISB-1016), which the claimant completes.
Should genetic test results be sent with DISB-1010?
No. The Patient Authorization on the form states that the medical and health information released excludes genetic test results. Otherwise, the form asks you to enclose copies of all relevant test results, investigative tests, pathology reports, hospital records and consultation reports, or any other relevant clinical findings.
Is DISB-1010 a fillable form?
Yes. Saskatchewan Blue Cross posts it as a fillable PDF on its member forms page. The statement runs two pages: the patient authorization and clinical history on page 1, and activities of daily living, prognosis, remarks, the notice to physician and your signature on page 2.