Missouri Public School Retirement System members applying for disability retirement give this three-page statement to every treating physician. It captures chief complaints, subjective symptoms, diagnoses with objective findings and test dates, lifting and positional restrictions, and the physician's opinion on whether the member is permanently incapable of earning a livelihood in any occupation, which is Missouri's legal standard.
Each of the member's treating physicians completes the whole statement, from present condition and diagnosis through restrictions, member incapacity and signature. The member gives a copy to each physician and is responsible for making sure records reach PSRS.
Download the current version from the source each time; forms change without notice.
PSRS Attending Physician Statement
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Missouri law requires that the disability render the member incapable of earning a livelihood in any occupation and be of a nature that warrants the assumption it will be permanent. The statement asks the physician whether, under that standard, the member is disabled from working any job, and why.
Medical and clinical records for the past three years or from the onset of the medical condition, whichever is longer. The physician sends them directly to PSRS together with the completed statement.
PSRS asks members to give a copy of the statement to all of their treating physicians, and each one completes and returns it. Members are responsible for contacting their physicians to make sure all relevant medical records are forwarded to PSRS.