PSERS PSRS-1236 Physician's Medical Report (PA)

Pennsylvania public school employees applying for PSERS disability retirement need their treating physician to describe current disabling symptoms, findings and limitations on this report and explain why the member cannot perform their job duties. PSERS' contracted medical examiners review it without examining the member, and the form comes only in the disability packet a PSERS representative provides during retirement counseling.

Who completes it

The member's treating physician completes the whole report. The member files the Application for Disability Retirement (PSRS-49); the packet also includes the Job Description (PSRS-1237) and the Release for Medical Records (PSRS-607).

Submitting and payment

How to submit it
The report must accompany the PSRS-49 application and PSRS-1237 job description filed with PSERS, and the member is responsible for submitting the medical documentation.
Who pays
The member is responsible for paying for the medical documentation submitted with the application.

Good to know

  • Members need at least five years of credited PSERS service and must have become disabled while an active member; the PSERS DC Plan has no disability benefit.
  • Applications must be filed within two school years of the member's last day of service or paid approved leave of absence.
  • PSERS approves, denies or renews benefits based on the medical documentation and the job description, so the report should tie limitations to specific duties.
  • PSERS requires ongoing submission of medical documentation to keep the benefit, and it can review or revoke a disability benefit at any time.

Get the official form

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

Physician's Medical Report

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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Frequently asked questions

Where can I download PSERS form PSRS-1236?

It is not posted online. A PSERS representative provides the Application for Disability Retirement Packet, which includes the Physician's Medical Report, during a retirement counseling session. The member then brings the report to the treating physician to complete.

Does PSERS examine the member in person?

No. PSERS' contracted medical examiners review the Physician's Medical Report and other documentation without a personal exam, which is why the report should explain clearly why the member cannot perform the duties described in the PSRS-1237 job description.