Qualified Providers Who Can Sign Proof Of Disability Forms

Illness, Injury or Incapacity:

• Licensed physician,
• Physician assistant,
• Advanced practice registered nurse (clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner)
• Physical therapist
• Occupational therapist
• Licensed chiropractor

Mental Health:

Any of the following providers can sign applicants PSN or MOF.

• Licensed physician
• Advanced practice registered nurse (clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner)
• Qualified mental health professional (a registered nurse certified as a
  clinical specialist in psychiatric nursing or as a nurse practitioner in psychiatric and mental health nursing, licensed independent clinical social worker, licensed professional clinical counselor, licensed psychologist, licensed marriage and family therapist, or licensed psychiatrist)

Substance Use Disorder:

Any of the following providers can sign applicants PSN or MOF.

• Licensed physician
• Qualified mental health professional (a registered nurse certified as a clinical specialist in psychiatric nursing or as a nurse practitioner in psychiatric and mental health nursing, licensed independent clinical social worker, licensed professional clinical counselor, licensed psychologist, licensed marriage and family therapist, or licensed psychiatrist)
• A substance use disorder treatment director
• An alcohol and drug counselor supervisor
• A licensed alcohol and drug counselor
• Or certified alcohol and drug counselor through the evaluation process established by the International Certification and Reciprocity Consortium Alcohol and Other Drug Abuse, Inc., or the Upper Midwest Indian Council on Addictive Disorder (UMICAD)