Skip to main content

Nova Scotia Digital Health Forms

Here you will find an inventory of available digital health forms. Most of these forms are available in your EMR software, however, they are made available here for providers without EMR access.

IMPORTANT NOTE: To ensure you are using the latest version of the forms, please access the updated versions in your EMR (sorting by date) rather than using a previously downloaded copy. Alternatively, your can download the most up to date version from this site each time before use. This will help prevent the accidental use of outdated forms.

For details on how to search for and use forms in your EMR, including how to filter Nova Scotia specific forms, please see the following documents:

Employment Support and Income Assistance Medical Form

New Improvements to the Employment Support and Income Assistance (ESIA) Medical Assessment Form

The Department of Community Services has launched an updated ESIA Medical Assessment Form. The PDF fillable form can be requested to support an ESIA client’s eligibility for enhanced rate, employment participation, or specific medical-related special needs.

Click here to view the FAQ related to this form or download the form using the attachment button below

June 5, 2024
.PDF

WCB - Primary and Emergency Care Report (NS) - (Formerly the Form 8/10)

Updated WCB - Primary and Emergency Care Report (NS) - (Formerly the Form 8/10)

January 3, 2024
.PDF

Attending Physician’s Statement - Short Term Disability Claim

Updated Attending Physician’s Statement - Short Term Disability Claim

Doctors have made it clear that insurance forms, especially the short-term disability form, are a primary source of administrative burden.

The Short-Term Disability (STD) form is the most frequently completed insurance form, filled out approximately 5,000 times per year in Nova Scotia by doctors. Before this work, 28 different STD forms specific to each insurance company could be presented to doctors for completion, often with varying degrees of complexities and requirements.

Click here to view the FAQ related to this form or download the form using the attachment button below

 

January 3, 2024
.PDF

Medical Status Report Form For Admission to a Long-Term Care Facility

March 20, 2024
.PDF

Adult Protection Medical Observation Form - Review of an Existing Adult Protection Court Order

March 20, 2024
.PDF

Adult Protection Medical Observation Form

March 20, 2024
.PDF

Lung Screening Program Referral Form

Please Note: 

  • This program is intended for asymptomatic individuals at high risk of developing lung cancer. If your patient has lung cancer symptoms do not refer them to this program but complete standard diagnostic imaging requisitions as appropriate.
  • This form is part of a pilot program that is currently being used in Central Zone only

March 20, 2024
.PDF

Sick Note Request - Physician Response (NS)

April 26, 2024
.PDF

Continuing Care Order includes Referral Form (NS)

May 8, 2024
.PDF

Attending Physician's Statement - Long Term Disability

May 8, 2024
.PDF

Paramedical Services - Physician Response

June 5, 2024
.PDF

811 LogoIKW Logo211 Logo