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EDD DE 2525XX: Physician Supplementary Certificate

When a California State Disability Insurance claimant's disability lasts beyond the recovery date on the original claim, EDD issues this supplementary certificate so the treating physician or practitioner can extend it. It asks for treatment status, current diagnosis with ICD codes, the next appointment and a new estimated return-to-work date. The claimant receives the paper version with the final payment.

Who completes it

The treating licensed physician or practitioner completes the Physician/Practitioner's Supplementary Certificate section and signs with an original handwritten signature on paper.

Submitting and payment

How to submit it
File it in SDI Online (find the claim, choose Submit Additional Medical Information, then 2525XX) or mail the paper form to the address printed on it, within 20 days of the mailing or online delivery date.

Good to know

  • Never enter 'unknown' or 'indefinite' as the estimated return-to-work date in question 10; EDD may contact you or refer the patient for an independent exam when an estimate looks long.
  • On paper, use black ink and one character per box, with no N/A, strikeouts, correction tape, labels, signature stamps or NPI numbers; include pages 1, 2 and 3.
  • License numbers must include all letters and numbers, such as NP54321 or DC12345, and dates use the MMDDYYYY format.
  • If the form is late, attach only the DE 2532 notice or a letter explaining the delay and requesting a late filing exception.

Get the official form

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

Physician/Practitioner's Supplementary Certificate

Official page

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.

See how Vero Documents works

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

What information is required on the DE 2525XX?

EDD's guide lists the required items: treatment status and last treatment date (question 1), current condition or diagnosis (2), next appointment date (3), ICD diagnosis codes (4), estimated return-to-work date (10) and whether disclosure to the patient would be detrimental (11). Leave fields that do not apply blank.

Can I attach work status reports to the DE 2525XX?

No, unless EDD asks for them. Attachments such as work status reports or lists of authorized signers are processed manually and can delay the claim. The only documents EDD expects are a DE 2532 notice or, for a late form, a letter requesting a late filing exception.