Try for free

NC Retirement Form 7A: Disability Medical Report

North Carolina public employees seeking disability retirement or Disability Income Plan (DIPNC) benefits need a licensed physician's detailed report on Form 7A. It covers ICD-10 diagnoses with onset dates, the disability timeline, medications, surgeries, vitals, a mental assessment for psychiatric diagnoses, job functions the member cannot perform, and whether incapacity is temporary or permanent, for review by the Retirement Systems Division and its Medical Board.

Who completes it

The member completes Section A, including the retirement system. A licensed physician completes Sections B through E, with Section C used only for mental diagnoses; physician assistant, registered nurse and nurse practitioner signatures are not accepted.

Submitting and payment

How to submit it
Return Form 7A to the Retirement Systems Division with the disability package and supporting documentation no older than six months. The member must have seen the signing physician within the past six months.
Who pays
The practice must not bill the Retirement Systems Division, which will not pay fees for furnishing the information; the member is responsible for their medical bills.

Good to know

  • ICD-10 codes and onset dates are required for each primary and contributing diagnosis, and full diagnosis names must be written out without abbreviations.
  • Stamped or digital signatures are rejected, as are forms with erasures, strikeovers or whiteouts. Radiology films and images are not accepted; send the reports.
  • The physician should document whether the member can do other types of work, and to what degree, in addition to the usual occupation.
  • If NCRS requests more information, the member has 90 days to obtain it from the physician and submit it, or the application may be denied.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Report for Disability Eligibility Review

Official pagePDF

How this list is checked

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.

Frequently asked questions

Can a nurse practitioner sign NC Retirement Form 7A?

No. Sections B through E must be completed by a licensed physician with an original signature. The form states physician assistant, registered nurse and nurse practitioner signatures will not be accepted, and stamped or digital signatures are rejected.

What documentation should accompany Form 7A?

Records no older than six months that support the diagnoses: physical findings, notes from the most recent exam, surgical, diagnostic and lab reports, mental status exam notes, radiology reports, and condition-specific tests such as EKG and echocardiogram for cardiac diagnoses or pulmonary function tests for COPD.

Which retirement systems use Form 7A?

The Teachers' and State Employees' Retirement System, Local Governmental Employees' Retirement System, Consolidated Judicial Retirement System, Legislative Retirement System and the Firefighters' and Rescue Squad Workers' Pension Fund. It is also part of the Disability Income Plan of North Carolina package.