The 28 Maryland forms clinicians complete, from the workers' comp Surgeon's Report and school and child care forms to DHS medical reports, the MOLST and guardianship certificates.
This page lists the Maryland forms clinicians complete, grouped by program, and each group links to its program hub. On workers' comp claims, the treating physician files the SF-2 Surgeon's Report through the Commission's online form. Schools and child care bring the most paperwork: the Record of Student Physical Exam, the MDH 896 Immunization Certificate, the MDH 4620 Blood Lead Testing Certificate and the school medication authorization. Social services offices send DHS/FIA 500 on work limitations and 500-C for the Temporary Disability Assistance Program.
The SF-2 is due within 72 hours after first treatment. Medicaid fee-for-service drug requests use the General Prior Authorization Form, while HealthChoice MCO members go through their plan. On child care medication forms, the prescriber line takes an original signature or stamp, never the parent's. Facilities must complete or offer the MOLST, and guardianship petitions generally need two CC-GN-019 certificates. Of these forms, 6 have a Spanish version. Vero Documents fills PDF forms from the visit note and the chart.
SF-2Treating physician/surgeon's first, progress and final report on the injury, diagnosis, causation, pre-existing conditions, disability and permanent defect.
Opens and documents a disability retirement claim; Section Three is the treating physician's medical report sent to the Agency's Medical Board for ordinary, accidental or special disability (employees, teachers, correctional officers, state police, LEOs, judges, legislators).
Certifies a disability expected to last 90+ days that prevents effective use of mass transit, for a Reduced Fare Photo ID on MDOT MTA services.
Healthcare/disability professional certification of the applicant's condition and functional limits for MobilityLink ADA paratransit eligibility in the Baltimore region.
Maryland Medicaid fee-for-service pharmacy prior authorization for age overrides, clinical criteria, non-preferred drugs and quantity limits (not for antipsychotics).
Prescriber's authorization (valid one year) and parent consent for school staff to give a medication at school.
Documents the physical examination required for students entering a Maryland public school for the first time (COMAR 13A.05.05.07).
MDH 4620Certifies blood lead test dates and results (or documents parental refusal) required before entry into child care, pre-kindergarten, kindergarten or first grade in Maryland.
OCC 1215Health inventory required for children entering licensed child care or nursery school (COMAR 13A.15-13A.18): parent history plus provider child health assessment.
Authorized prescriber's order and parent consent for medication given to a camper at a Maryland youth camp (COMAR 10.16.07).
Medical evaluation of child care providers, staff and household members showing they can safely care for children of the ages served.
Prescriber order and parent consent for medication administration in Maryland licensed child care.
Combined asthma action plan and prescriber authorization for asthma medication in Maryland licensed child care (used instead of OCC 1216).
Allergy/anaphylaxis emergency plan and prescriber authorization for epinephrine and antihistamines in Maryland licensed child care (replaces OCC 1216 for these medications).
Seizure action steps and prescriber authorization for seizure/emergency medication in Maryland licensed child care (used without OCC 1216).
Certifies a student's vaccine dates for Maryland preschool and K-12 admission and documents a permanent or temporary medical contraindication (or parent religious objection).
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, enduring medical order form for CPR and other life-sustaining treatments, valid in all Maryland health care facilities and programs and for EMS.
Clinician's capacity assessment certificate (Md. Rule 10-202) used to decide whether an individual needs a guardian of the person and/or property and to identify less restrictive alternatives.
Registered certifying provider issues a written certification that the patient has a qualifying condition expected to be relieved by medical cannabis.
Provider report of a reportable disease or condition (including STDs such as chlamydia, gonorrhea and syphilis) to the local health department.
DHR/SSA 180Mandated reporter's written report of suspected child abuse or neglect following the immediate oral report.
Physician, CRNP or PA certifies that terminating electric/gas service would aggravate a serious illness or prevent use of life-support equipment, delaying termination (customer must make a payment agreement within 30 days) under COMAR 20.31.03.
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 physician or surgeon submits the first report to the Workers' Compensation Commission within 72 hours after first treatment, using the Commission's online form, where every field is required. Progress and final reports follow, with the final at discharge. The SF-2 covers the injury, diagnosis, causation, pre-existing conditions, disability and any permanent defect. Permanency evaluations are narrative reports with no form.
A certified or licensed health professional: a physician, NP, PA, psychologist, licensed social worker or therapist. The 500-A, Verification of Disability, supports a SNAP work-requirement exemption. The customer completes Section 1, and the provider completes Section 2 when the caseworker asks for it. A physician signature is not required, and an obvious disability needs no verification. A Spanish version is available.
A licensed physician, psychologist, physician assistant, LCSW-C or nurse practitioner. The Certificate, Guardianship Capacity Assessment, helps the court decide whether a person needs a guardian of the person or property and whether less restrictive alternatives exist. It is signed under penalties of perjury and filed with the circuit court with the petition. Two certificates are generally required.
A licensed physician, certified nurse practitioner or PA completes Section One of Form PSC-801, certifying that ending electric or gas service would aggravate a serious illness or stop the use of life-support equipment. The form goes back to the customer's utility and delays termination, and the customer must make a payment agreement within 30 days. Filing it also enrolls the household in the utility's emergency medical equipment notification program.