Michigan DHS-54E Medical Needs - PATH

Michigan Family Independence Program clients who cannot take part in PATH employment activities because of illness or injury need medical verification, and the DHS-54E is the PATH version of that form. The clinician states the incapacity, how long it will last and any work restrictions, so the MDHHS specialist can grant a deferral or set up a reasonable accommodation.

Who completes it

An M.D., D.O., nurse practitioner or physician assistant completes it after the client identification section; Michigan's FIP manual specifically notes that NPs and PAs can complete the DHS-54E.

Submitting and payment

How to submit it
Return it to the MDHHS specialist who requested it; the form is supplied per case and is not posted publicly.
Who pays
Michigan's FIP manual (BEM 230A) lets MDHHS authorize a general medical exam or payment for a medical report when one is needed to verify an incapacity.

Good to know

  • A short-term incapacity, expected to last under three months, supports a PATH deferral of up to three months.
  • Incapacity lasting more than 90 days is referred to the Disability Determination Service, which uses the DHS-49 series of reports.
  • It can also verify pregnancy complications, or a parent's need to stay home to care for a spouse or child with disabilities.
  • After a DDS denial, a DHS-54E can document a new or worsening condition expected to last more than 90 days before a new DDS referral.

Get the official form

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

Medical Needs - PATH

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.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Can a nurse practitioner complete Michigan's DHS-54E?

Yes. Michigan's FIP manual (BEM 230A) states that an N.P. or P.A. can complete the DHS-54E, Medical Needs-PATH. It is accepted to verify short-term incapacity, pregnancy complications and disability claims for PATH deferral, alongside the DHS-54A and other written statements.

What happens if the incapacity will last more than 90 days?

The client must verify that the disability will last longer than 90 days, apply for Social Security benefits, and be referred to the Disability Determination Service. DDS develops the medical evidence and decides whether the client is deferred from PATH on a long-term basis.