Members of the Ohio Public Employees Retirement System who apply for a disability benefit need this report from each MD or DO listed on their application. The attending physician states whether the member is permanently disabled from their last public job, meaning a condition expected to last at least 12 months, and documents findings by body system. OPERS' third-party administrator, MMRO, reviews it with the records before the OPERS Board of Trustees decides.
The member completes Step 1 with personal and contact details. The attending physician, who must be a licensed and practicing MD or DO, completes Steps 2 to 5: physician information, treatment dates, the disability determination with prognosis and signature, and findings by body system with treatment history.
The member enters their Social Security number or OPERS ID, name, date of birth, gender, address, home, work and cell phone numbers, email, and the preferred number and time of day for contact. OPERS marks this step as required: if it is not completed, the whole form is invalid. It is worth checking before the physician's office starts on the clinical pages.
Enter the physician's name with MD or DO checked, specialty, ABMS board certification and any sub-certification, office mailing address, phone, fax and email. Add a primary office contact with phone, fax and email, office hours, the preferred time to call and the preferred contact method (phone, fax or email). This step is also required for the form to be valid, and OPERS' third-party administrator uses these details if it contacts the office.
Record the dates the physician has treated the member, from and to, and how often the member is seen for the disabling condition: monthly, quarterly, semiannually, annually or other. Add the date of the last office visit for the disabling condition. The records attached to the form should cover the last 12 months of that treatment.
Answer whether the member is permanently disabled from their last public employment position: the condition must be expected to last at least 12 months and prevent the member from doing that job. Complete either the YES or the NO section in full, or the form is invalid. YES asks for the primary disabling condition, its ICD code, the date the illness or injury occurred, the date it became permanently disabling and whether it has progressed. Include the test results behind the diagnosis.
If the answer was NO, first give the date the illness or injury occurred, the expected date the member could return to their public job, and whether they could return with restrictions or limitations, with a description. Part 2 is required on every form: write the prognosis for recovery, print the physician's name, sign (the signature line says not to print or type the name), date it and check MD or DO.
List current medications and medical history, including hospitalizations in the past five years with facilities, dates and reasons. Record temperature, blood pressure, height, weight, pulse, respiratory rate and general appearance, then complete only the body-system sections related to the disabling condition: vision, hearing, respiratory, cardiovascular, digestive, genitourinary, hematological, skin, endocrine, musculoskeletal, neurological, malignant neoplasms, immune and other. Each prompts for specific evidence, such as the New York Heart classification, EMG and nerve conduction results or pathology reports.
Completed only for disabling psychological conditions. List current medications and psychiatric history with hospitalizations in the past five years. The mental status assessment asks for current signs and symptoms that support the diagnosis (sleep, interest, guilt, energy, concentration, appetite, psychomotor changes, suicidal ideation) and findings on appearance and behavior, orientation, mood and affect, speech, thought process, thought content, perceptions, cognition and social functioning, plus results of any neuropsychiatric testing.
Describe historical treatment, including successful and failed treatments, and the current treatment. Then answer whether the member has shown medical improvement with current treatment and, if so, rate it as fair, moderate, good or excellent. OPERS states that the clinical findings, diagnoses and test results in the report are used to adjudicate the disability determination.
Download the current version from the source each time; forms change without notice.
Report of Physician
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.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Only the member's attending physician who is a licensed and practicing MD or DO can complete Steps 2 to 5. Each physician listed on the disability application completes a separate DR-APS, and leaving one out delays processing. Records from other clinicians involved in the disabling condition can still be submitted, since OPERS asks for records from all providers involved in that care.
The form asks for all medical and psychological records from the last 12 months: office notes, clinic and ER visits, labs, all test results and discharge summaries. Send report findings only, because OPERS cannot accept digital media. OPERS' records guide adds that only records relevant to the disabling condition are needed, and that any release fees are the member's responsibility.
For OPERS, the disabling condition must be expected to last at least 12 months and prevent the member from performing the duties of their last public employment position. The physician answers yes or no in Step 4. Members are first evaluated under this own-occupation standard, and the decision also draws on MMRO's review and any independent exam.
MMRO usually calls the member within five business days to acknowledge the application, reviews the records and may order an independent medical or psychiatric exam with a credentialed physician it selects. Its recommendation goes to an OPERS medical consultant, who advises the Board of Trustees. Supporting medical information must reach OPERS by the end of the business day before the first exam.