The 25 Maine forms clinicians complete, from the M-1 workers' comp report and BMV medical forms to MaineCare drug requests, the Blue Paper and Death with Dignity reports.
This page lists the Maine forms clinicians complete, grouped by program, and each group links to its program hub. On workers' comp claims, the treating provider files the M-1 Diagnostic Medical Report with diagnosis, causation, treatment plan and work capacity. The Bureau of Motor Vehicles uses CR-24, the Driver Medical Evaluation, the MVE-103 eye exam and PS-18 for disability plates and placards. MaineCare drug requests go on Form 20420, and emergency psychiatric admission starts with the MH-100.A Blue Paper.
The M-1 is due within 5 business days of the exam, every 30 days during treatment and at the end of care, and insurers may withhold payment for late reports. MaineCare has no MCOs, so Form 20420 covers every member. Deaths are certified in DAVE, and cannabis certifications are created in a state portal. School immunization exemptions are letters from the primary care provider. The sample school medication authorization comes in Spanish. Vero Documents fills PDF forms from the visit note and the chart.
Reports the diagnosis, causation opinion, treatment plan and work capacity (regular, modified or none, with restrictions) of an injured worker at the initial, progress and final visits.
Healthcare provider records diagnoses, diagnostic basis, functional limitations, ability to perform essential job functions (with accommodations) and permanence, under Maine law, for a MainePERS disability retirement application.
Advisory report by a medical or paramedical professional on a physical, emotional or mental condition that could affect safe driving, applied under Maine's Functional Ability Profile rules to determine license eligibility.
MVE-103Licensed vision examiner's report of acuity, continuous visual field and conditions under the Functional Ability Profile rules, including bioptic use and exceptional-case review requests.
CR-24 AddendumSupplements the Driver Medical Evaluation with narcolepsy/cataplexy treatment, adherence, Epworth Sleepiness Scale score and cataplexy episode details.
Applies for a permanent or temporary (max 6 months) disability placard or disability plates, with the medical provider's statement of the qualifying condition (including recovery from childbirth).
Form # 20420General MaineCare pharmacy prior authorization request for non-preferred drugs and drugs subject to PA without their own form.
Prior authorization request for MaineCare-covered hearing aids.
Sample school medication authorization with parent consent and a healthcare provider statement/order for medication during school hours.
Biennial certification that a nursery school licensee/staff member is free from communicable disease (22 M.R.S. 8402).
Written medical exemption from Maine school, child care and camp immunization requirements, the only exemption allowed for schools since 2021.
Appendix NS-2-GMedical 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.
Electronic vital events system in which Maine medical certifiers enter the medical certification of death before the record can be registered.
Actionable medical order for people facing terminal illness or advanced frailty, based on the National POLST form.
Attending physician certifies compliance with each requirement of the Maine Death with Dignity Act when prescribing medication.
Consulting physician confirms terminal diagnosis, competence, voluntariness and informed decision of a Death with Dignity patient.
Attending physician's follow-up report on the outcome after a Death with Dignity prescription.
Emergency application, certifying examination and judicial endorsement for involuntary admission of a mentally ill person who poses a likelihood of serious harm (34-B M.R.S. §3863).
Second examiner's certificate, within 24 hours of a Blue Paper admission, that the patient is mentally ill and poses a likelihood of serious harm so the hold may continue (34-B M.R.S. §3863(7)).
Licensed medical provider certifies a patient for the medical use of cannabis; the online service produces the standard printed certification the patient uses as their designation card.
Online non-emergency report of suspected child abuse or neglect by eligible mandated reporters.
Online report of suspected abuse, neglect or exploitation of an incapacitated or dependent adult to Maine APS.
Report of a notifiable condition or disease (reporter, patient, clinical/lab and provider information) to Maine CDC.
Licensed physician's evaluation of the nature, permanence and functional effect of a permanent physical disability so the Commissioner can issue a special permit to hunt, trap or fish in an otherwise prohibited manner or time.
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The treating provider sends the M-1 Diagnostic Medical Report to the employer and the employee within 5 business days of the exam or of notice of the injury, every 30 days during ongoing treatment, and within 5 working days after treatment ends. Report fees are limited to the Board's fee schedule, and the insurer may withhold payment for a report that is late or not on the prescribed form.
A physician, physician assistant, nurse practitioner or registered nurse completes the Medical Provider's Statement and gives the date of the last assessment. Temporary placards last up to 6 months, with set options for a cesarean delivery (1 week) and the birth of a preterm infant (up to 6 months). The applicant can apply at any BMV branch or send the form to the BMV Disability Clerk.
Section 2 of MH-100.A can be completed by a licensed physician, psychologist, PA, NP, certified psychiatric clinical nurse specialist or LCSW. Any adult can be the applicant in Section 1, and a judge or justice of the peace endorses it before the person goes to the hospital. Within 24 hours, a physician or licensed clinical psychologist who was not the first examiner completes the 24-Hour Certificate.
Through the state's Medical Cannabis Certifications Online Portal, which has been mandatory since 2015. A Maine-licensed physician, NP or PA in good standing creates the certification, prints it on paper ordered through the portal, signs it and gives it to the patient, who uses it as their card. Maine has no qualifying-condition list, and patients do not register with the state.