Coverage
Every form PatientPapers completes.
PatientPapers completes these 113 forms, from 50 states and DC plus federal forms, insurer forms and letters.
Work absence (FMLA)
Leave certifications: the Department of Labor's forms, and the versions insurers such as MetLife and The Standard send in their place.
| Jurisdiction | Form |
|---|---|
| Federal | Care for a family member (WH-380-F) |
| Federal | Employee's own condition (WH-380-E) |
| Federal | Military caregiver — covered veteran (WH-385-V) |
| Federal | Military caregiver — current servicemember (WH-385) |
| Nationwide | MetLife — care for a family member (DIS-HCPC-FMLA-FMHC) |
| Nationwide | MetLife — employee's own condition (DIS-HCPC-FMLA-ESHC) |
| Nationwide | Standard Insurance — care for a family member (SI 14602) |
| Nationwide | Standard Insurance — employee's own condition (SI 14564) |
Guides for clinicians: how to fill out the WH-380-E, how to fill out the WH-380-F and FMLA paperwork for doctors.
Disabled parking
State and DC disabled-parking placard and plate certifications.
| Jurisdiction | Form |
|---|---|
| Alabama | Parking permit (MVR-32-6-230) |
| Alaska | Parking permit (Form 861) |
| Arizona | Parking permit (96-0104) |
| Arkansas | Parking permit (Form 10-336) |
| California | Parking permit (REG-195) |
| Colorado | Parking permit (DR 2219) |
| Connecticut | Parking permit (B-225P) |
| Delaware | Parking permit (MV474) |
| District of Columbia | Parking permit (Practitioner certification) |
| Florida | Parking permit (HSMV-83039) |
| Georgia | Parking permit (MV-9D) |
| Hawaii | Parking permit (PA-3) |
| Idaho | Parking permit (ITD-3392) |
| Illinois | Parking permit (VSD 62.33 ADA) |
| Indiana | Parking permit (SF 42070) |
| Iowa | Parking permit (letter, §321L.1(8)) |
| Kansas | Parking permit (TR-159) |
| Kentucky | Accessible plates (TC 96-347) |
| Kentucky | Parking permit (TC 96-347) |
| Louisiana | Parking permit (DPSMV-1966) |
| Maine | Parking permit (PS-18) |
| Maryland | Parking permit (VR-210) |
| Massachusetts | Parking permit (Sections D & E healthcare provider) |
| Michigan | Accessible plates (MV-110) |
| Michigan | Parking permit (BFS-108) |
| Minnesota | Parking permit (PS2005) |
| Mississippi | Parking permit (76-104) |
| Missouri | Parking permit (Form 1776) |
| Montana | Parking permit (MV5-DSB) |
| Nebraska | Parking permit (Handicapped Permit) |
| Nevada | Parking permit (SP-27) |
| New Hampshire | Parking permit (RDMV130) |
| New Jersey | Parking permit (letter, N.J.A.C. 13:20-9.1) |
| New Mexico | Parking permit (MVD 10383) |
| New York | Parking permit (MV-664.1) |
| North Carolina | Parking permit (MVR-37A) |
| North Dakota | Parking permit (SFN 2886) |
| Ohio | Accessible plates (BMV 4834) |
| Ohio | Parking permit (Placard prescription) |
| Oklahoma | Parking permit (302DC) |
| Oregon | Parking permit (735-265) |
| Pennsylvania | Accessible plates (MV-145) |
| Pennsylvania | Parking permit (MV-145A) |
| Rhode Island | Parking permit (Physician certification) |
| South Carolina | Parking permit (RG-007A) |
| South Dakota | Parking permit (MV-044) |
| Tennessee | Parking permit (RV-F1310301) |
| Texas | Accessible plates — disabled veteran / disabled peace officer (VTR-615/617) |
| Texas | Parking permit (VTR-214) |
| Utah | Parking permit (TC-842) |
| Vermont | Parking permit (VS-113) |
| Virginia | Parking permit (MED 10) |
| Washington | Parking permit (420-073) |
| West Virginia | Parking permit (DMV-41-TR) |
| Wisconsin | Accessible plates (MV2162) |
| Wisconsin | Parking permit — permanent (MV2548) |
| Wyoming | Parking permit (FSDI-915) |
Workers' comp
Duty-status and treating-physician reports after a work injury, the federal workers' comp forms (OWCP), and the state board’s own sheet where it prescribes one.
| Jurisdiction | Form |
|---|---|
| Arkansas | Physician report (Form 3) |
| Connecticut | Physician’s permanent impairment evaluation (Form 42) |
| Federal | Federal workers’ comp — attending physician’s report (CA-20) |
| Federal | Federal workers’ comp — duty status report (CA-17) |
| Florida | Uniform medical treatment/status reporting form (DFS-F5-DWC-25) |
| Georgia | Job analysis (WC-240a) |
| Georgia | Medical report (WC-20a) |
| Maine | Diagnostic medical report (M-1) |
| Missouri | Medical treatment form (WC-9) |
| Montana | Medical status form, version 1 (five-band grid) |
| Montana | Medical status form, version 2 (hours per day and safety questions) |
| Montana | Medical status form, version 3 (written restrictions and weight table) |
| Nevada | Progress report and certification of disability (D-39) |
| New Hampshire | Workers’ compensation medical form (75 WCA-1) |
| New Mexico | Form letter to health care provider |
| New Mexico | Provider’s report of physical ability |
| North Carolina | Evaluation for permanent impairment (Form 25R) |
| North Carolina | Workers’ compensation medical status questionnaire |
| Ohio | Physician report of work ability (MEDCO-14) |
| Pennsylvania | Workers’ compensation medical report (LIBC-9) |
| Rhode Island | Physician’s notice of release to work (DWC-27/28) |
| South Carolina | Physician’s statement (Form 14B) |
| Tennessee | Final medical report at maximum medical improvement (C-30A) |
| Tennessee | Physician certification of permanent restrictions (LB-1109) |
| Tennessee | Standard medical report for industrial injuries (C-32) |
| Utah | Attending physician’s statement (Form 043) |
| Vermont | Cognitive work capabilities form |
| Vermont | Health care provider report (HCP1) |
| Vermont | Work capabilities form (Form 20) |
| Virginia | Attending physician’s report (Form 6) |
| Wisconsin | Medical report on industrial injury (WKC-16-E) |
| Wisconsin | Physician’s report on eye injuries (WKC-16-A) |
Disability claims
Attending physician statements for short- and long-term disability insurance claims.
| Jurisdiction | Form |
|---|---|
| Nationwide | Lincoln — long-term disability physician statement (GLC11750LTD-C) |
| Nationwide | Lincoln short-term disability — attending physician statement (GLC-01817) |
| Nationwide | MetLife — disability attending physician statement (APS-STD-LTD-5320) |
| Nationwide | New York Life Group Benefit Solutions — physician's statement (GB-608066) |
| Nationwide | Standard Insurance — long-term disability attending physician's statement (SI 3379) |
| Nationwide | Standard Insurance — short-term disability employee/attending physician's statement (SI 2047) |
| Nationwide | Unum — long-term disability attending physician statement (CL-1019) |
| Nationwide | Unum — short-term disability attending physician statement (CL-1104) |
Jury service
The court's own medical excuse sheet, where the jurisdiction publishes one. Everywhere else, the composed jury-excuse letter does the job.
| Jurisdiction | Form |
|---|---|
| Arizona | Request for medical excuse (AOCGN501F) |
| Connecticut | Part II, medical disqualification (JD-JA-47) |
| New Jersey | Physician certification (CN 12308) |
Letters & notes
Notes we compose on your letterhead, with your practice name, logo and office address at the top: return-to-work, work restrictions, ADA accommodation, jury duty, and school or daycare.
| Jurisdiction | Form |
|---|---|
| Nationwide | ADA accommodation support letter |
| Nationwide | Jury duty medical excuse / postponement |
| Nationwide | Return-to-work / fitness-for-duty note |
| Nationwide | School / daycare medical note |
| Nationwide | Work restriction note |
On keeping up. States change these forms without notice, so rather than claim we keep up, we show our working. Inside the app, every form says when it was last confirmed, whose copy was checked, that it could not be confirmed at all, or, for a letter we compose, that there is no edition to check. A form we know has been superseded comes off this list until it is replaced.
This list is generated from the app’s own form catalog, and a test fails if it ever disagrees with what the software ships. A form on it is one PatientPapers completes for your signature. It is not a statement that any employer, insurer or agency must accept the result — no software can promise that.