The 28 District of Columbia forms that ask for a clinician's input, from school health certificates and DMV certifications to Paid Family Leave, MetroAccess and MOST.
This page lists the 28 District of Columbia forms that ask for a clinician's input, grouped by program. School forms come up every year: the Universal Health Certificate, the Oral Health Assessment Form and the Medication and Medical Procedure Treatment Plan. Drivers 70 and older need the Mature Driver Fitness to Drive Certification at each renewal. DC Paid Family Leave uses the PFL-MMC, PFL-FMC and PFL-PMC certifications, and private-sector workers' comp claims use the Form 12 Medical Report.
Many DC forms are online. Notifiable disease and HIV, STD and hepatitis case reports go through the DC Reporting and Surveillance Center, Death with Dignity compliance forms are entered in the DC Health portal, and medical cannabis recommendations are made in myABCA. MetroAccess applications need an original hand signature, with no stamp, copy, fax or scan. Copies and faxes of a signed MOST are valid. 9 forms here have a Spanish version, including the school health forms and the Paid Family Leave certifications.
Form No. 12 DCWCAttending physician's report of the accident history, diagnosis, treatment, prior impairment, expected length of disability and return-to-work date for a private-sector DC workers' compensation claim.
Formulario de certificación médica que justifica la licencia familiar
Documents a family member's serious health condition and the care the claimant will provide for DC Paid Family Leave family leave.
Formulario de certificación médica que justifica la licencia médica
Documents the claimant's serious health condition (pregnancy, inpatient care, chronic condition, continuing treatment) and the continuous/intermittent leave needed for DC Paid Family Leave medical leave.
Formulario de certificación médica que justifica la licencia prenatal
Certifies pregnancy-related prenatal care or incapacity for DC Paid Family Leave prenatal leave.
Certification by a licensed medical practitioner that a driver aged 70 or older can safely drive, required at license renewal.
DMV-MER-002Informe Médico/de Visión
Licensed medical practitioner's and/or eye doctor's report on a condition (seizures, dementia, insulin-treated diabetes, vision impairment, etc.) that may impair safe driving, used to issue, restrict or limit a license.
Applies for ADA complementary paratransit (MetroAccess) eligibility in DC, suburban Maryland and Northern Virginia; the provider certification feeds the in-person functional assessment.
DMV-MF-DPLP-01Solicitud para Carteles y Etiquetas de Estacionamiento para Discapacitados
Applies for or renews disability parking tags (plates) and/or a temporary or long-term placard, with a medical practitioner's answers on mobility impairment.
Certifies a qualifying disability so a person under 65 can get the Reduced Fare (half-fare) Disability SmarTrip photo ID for Metrobus and Metrorail.
DC fee-for-service Medicaid prior authorization request for surgery, DME, medical, pharmacy, dental, eyewear, hospice, home health and private duty nursing services.
Physician/APRN order prescribing long-term care services and supports (e.g. personal care aide, EPD waiver services) that triggers the DHCF LTCSS assessment.
Provider order and parent authorization for medications and medical procedures to be given at school (D.C. Code 38-651.03); renewed annually.
Annual dental provider assessment required for students in DC schools and child care (D.C. Code 38-602).
Certificado Universal de Salud
Annual health certificate required for every child attending DC public, charter, private schools, child care and youth programs (D.C. Code 38-602): physical exam, immunizations, screenings, health history.
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 CPR, medical interventions and artificial nutrition for District patients with serious illness.
Documents the attending physician's compliance with the DC Death with Dignity Act when prescribing covered medication.
Consulting physician confirms diagnosis, prognosis and capacity of a patient requesting medication under the DC Death with Dignity Act.
Psychiatrist or psychologist reports whether a DC Death with Dignity patient has a disorder impairing judgment.
Registered DC practitioner recommends medical cannabis for a patient registering with the DC Medical Cannabis Program.
Online non-emergency report of suspected child abuse or neglect by a mandated reporter.
Online case report of HIV, syphilis, gonorrhea, chlamydia and viral hepatitis B and C (TB through the companion TB Case Report Form).
Online case report of a District of Columbia notifiable disease or condition other than HIV, STD, viral hepatitis B/C and TB.
Reports a person bitten by an animal, potentially exposed to rabies, or given rabies post-exposure prophylaxis.
Reports HIV, hepatitis B or syphilis diagnosed in a pregnant woman, with linkage-to-care, treatment and delivery hospital information.
Treating physician certifies whether a DC patient uses electrical medical/life-support equipment and whether loss of power would be immediately life-threatening, for Pepco's medical equipment notification program and serious-illness protections.
Verification letter used when a Housing Choice Voucher participant requests a disability accommodation; a physician, licensed health professional or social service/disability agency professional verifies the disability-related need.
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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Every DC driver aged 70 or older, at each license renewal. A licensed medical practitioner completes Section B, certifying that the driver can drive safely. The driver returns the printed form to DMV with the renewal, or it can be completed through the DMV online transaction. DMV may issue a 45-day temporary license while it waits for the certification. Drivers with a condition such as seizures or dementia may also need the DMV-MER-002 Medical/Eye Report.
Every year. DC Health requires it for every child attending public, charter or private schools, child care and youth programs under D.C. Code 38-602. A physician, NP or PA completes Parts 2 to 5, covering the physical exam, immunizations, screenings and, for adolescents, sexual history, and signs or stamps it. The parent completes Part 1 and gives the form to the school health suite. Students also need an annual Oral Health Assessment from a dentist.
The one that matches the leave: PFL-MMC for the claimant's own serious health condition, PFL-FMC for a family member's condition, and PFL-PMC for prenatal leave. The licensed health care provider completes the provider part, and the claimant uploads the form with the application in the DC PFL benefits portal. A medical leave claim can't be filed until the form is signed. The forms also come in Spanish, French, Chinese, Korean, Amharic and Vietnamese.
Within 20 days, under section 8(d). The attending physician completes the whole form, covering accident history, diagnosis, treatment, prior impairment, expected length of disability and return-to-work date, and files it with the DOES Office of Workers' Compensation and the employer or carrier. It applies to private-sector claims; DC government employees are covered by the Office of Risk Management's public-sector program.