Members of the Texas County & District Retirement System applying for disability retirement ask their attending physician to complete this three-page statement for the TCDRS Medical Board. It records vitals, diagnosis, onset, etiology, severity and course, treatment response, abnormal findings by system, physical and mental limitations, and a certification on whether the member is incapacitated for any gainful occupation, likely permanently.
The member completes Member Information and signs the Member Authorization. The attending physician completes Physician Information, Medical Condition(s), Physician Certification and Physician Authorization.
Download the current version from the source each time; forms change without notice.
Physician's Statement
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Under the TCDRS Act, a member is entitled to disability retirement if they are mentally and/or physically incapacitated to engage in any gainful occupation and the incapacity is likely to be permanent. The physician certifies whether the member's condition clearly comes within that provision.
Photocopies of a current history and physical, a hospital discharge summary, a narrative report or comprehensive consultation, and other pertinent information. TCDRS asks that the attachments contain references to all items on the form so the Medical Board can review them.