The 14 Arizona forms that ask for a clinician's input, from DES disability verification and AIA sports physicals to immunization exemptions and the orange DNR.
This page lists the 14 Arizona forms that ask for a clinician's input, grouped by program. The ones you meet most are the FAA-1249A, Verification of Disability, which DES uses for Cash Assistance and Medical Assistance eligibility, and the AIA Form 15.7-B annual preparticipation physical. ADHS publishes the Medical Exemption Form for school and child care immunizations and the Prehospital Medical Care Directive, the statutory orange DNR form under A.R.S. 36-3251.
Several of these forms have unusual rules. The Prehospital Medical Care Directive must be printed on orange paper. AIA accepts physicals from naturopathic physicians and certified chiropractic sports physicians, and a physical counts for the next school year if done on or after March 1. Medical marijuana certifications must be on the ADHS form, and a minor also needs a reviewing physician. 6 forms here have a Spanish version, including the immunization exemption and the APS Medical Care Program application.
Attending physician's objective medical evidence supporting an ASRS member's claim under the ASRS Long Term Disability Income Program.
Examining provider's annual physical exam and clearance required under AIA Bylaw 15.7 for interscholastic participation.
Formulario de Exención por Razones Médicas
Official ADHS format documenting a temporary or permanent medical exemption, or lab evidence/history of immunity, for school, preschool and child care immunization requirements.
Medical documentation required by 7 CFR 246.10(d) for WIC to issue exempt infant formula, WIC-eligible nutritionals or non-contract formula, and to modify WIC foods, for a participant with a qualifying medical condition.
Medical documentation required by 7 CFR 246.10(d) for WIC to issue exempt infant formula, WIC-eligible nutritionals or non-contract formula, and to modify WIC foods, for a participant with a qualifying medical condition.
Portable medical order for seriously ill or frail patients recording CPR and treatment-intensity orders; Arizona uses the National POLST Form.
Statutory orange DNR form (A.R.S. 36-3251) that EMS providers honor to withhold resuscitation from a qualified individual.
Department-provided written certification in which the physician attests to diagnosing or confirming a debilitating medical condition under A.R.S. 36-2801 and that the patient is likely to benefit from medical marijuana.
Second (reviewing) physician reviews the minor's records and also recommends medical marijuana for a qualifying patient under 18.
Reports a reportable communicable disease (A.A.C. R9-6-202), with disease-specific sections for STI/HIV, syphilis and tuberculosis.
Solicitud del Programa de Cuidado Médico
Licensed medical professional certifies that a household member depends on life-sustaining medical equipment (danger if off more than 4 hours) or has a limiting physical/mental condition, so APS gives advance notice of planned outages.
Licensed medical practitioner certifies that a patient uses a life-sustaining medical device or needs continuous electric service, so TEP flags the account for outage alerts and planned-outage notice.
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 and their requirements change without notice, so check the official page for the current version before you complete one.
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A qualified professional: a physician, physician assistant, nurse, nurse practitioner, licensed or certified psychologist, or social worker. The professional completes the Medical Information section on pages 1 to 3, stating whether a temporary or permanent physical or mental condition prevents work or participation in Jobs activities, and how long it is expected to last. The form goes back to the DES Family Assistance Administration office or case worker.
An M.D., D.O., N.D. or N.M.D., N.P., PA-C or certified chiropractic sports physician (CCSP). Form 15.7-B is the annual physical exam and clearance that AIA Bylaw 15.7 requires for interscholastic sports. A physical done on or after March 1 counts for the next school year. The student returns the form to the school athletic office.
The Prehospital Medical Care Directive is signed by a licensed health care provider, such as a physician, NP or PA, together with the patient or representative and a witness. The provider statement is on side two. A.R.S. 36-3251 calls for an orange background, so the form must be printed on orange paper. EMS providers honor it to withhold resuscitation. The patient keeps it, and a wallet-size version is available.
An Arizona-licensed MD, DO, naturopathic physician or homeopathic physician, on the Department-provided Physician Certification form. The physician attests to diagnosing or confirming a debilitating condition under A.R.S. 36-2801 and initials attestations that include PTSD and pregnancy counseling. The patient uploads it with the registry card application in the ADHS Individual Licensing Portal. Patients under 18 also need a Reviewing Physician Certification from a different physician.