Tennessee Consolidated Retirement System members applying for ordinary or accidental disability retirement ask their attending physician to complete this five-page report. It records primary and secondary diagnoses, body-system findings from musculoskeletal to neoplasms, prognosis, and whether the impairment has lasted or will last 12 continuous months, prevents past work, and prevents all other gainful employment.
The applicant completes and signs Section 1, which authorizes discussion of the disability with TCRS. The attending physician completes Section 2, filling in only the parts that apply to the patient.
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Attending Physician's Report of Disability
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The applicant. The form states that the expense of furnishing the information must be paid by the applicant, and it asks the physician to attach office notes, hospital summaries, test results and any other medical information available.
Three yes/no questions: whether the impairment has lasted or is expected to last 12 continuous months, whether it has prevented performance of past work, and whether it prevents all other gainful employment. If not, the physician indicates the type of work the applicant can perform.