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DOH-5143 Medical Report for Determination of Disability-2026
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- Click ‘Get Form’ to open the DOH-5143 Medical Report in our editor.
- Begin by filling out Section I – Identification. Enter the patient's name, date of birth, sex, case number, and address. Ensure all details are accurate for proper identification.
- In the Medical Report section, provide a diagnosis and the date of the last exam. Include height and weight measurements as required.
- For Exertional Functions, indicate what the individual is capable of doing by selecting appropriate options for lifting, carrying, standing, walking, sitting, pushing, and pulling.
- Next, check any limitations under Non-Exertional Functions across sensory, postural, manipulative, environmental, and mental categories.
- Finally, ensure that the provider signs the form and includes their printed name, date signed, specialty, office address, and phone number before submitting it along with medical records.
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Related links
DOH 5143 (LDSS-486T) - Medical Report for Determination of Disability | OHIP Eligibility Forms, Notices, and Systems Repository
Mar 25, 2019 DocHub our certified Information. Division of Disability Services toll-free at 1-888-285-3036. physical disability, perceived disability,