Treating physician's statement, required by 840 CMR 10.06(1)(b), on incapacity, permanence and causation (accidental, ordinary, presumption, violent act injury) for a Massachusetts public employee's disability retirement application to one of the 104 local retirement boards.
- Completed by
- Licensed medical doctor treating the applicant for the claimed disability
- Issued by
- Massachusetts Public Employee Retirement Administration Commission (PERAC)
- Format
- Fillable PDF
- Language
- English