DTA's EAEDC Medical Provider Statement

Here are the current procedures for DTA (As of December 2022): 

EAEDC applicants and people doing an EAEDC reevaluation need to use the EAEDC Medical Provider Statement to verify disability if DTA can't get proof of disability from another source. The client must have the form completed by their medical provider. A doctor, physician assistant, nurse practitioner, osteopath, psychologist, podiatrist, licensed clinical social worker, licensed mental health counselor or psychiatrist, or for pregnancy-related incapacity a certified nurse midwife licensed by the Commonwealth of Massachusetts who is familiar with the patient’s condition or who has conducted an exam within the last 30 days.

If a client cannot able to get the form filled out because there is not an appointment available with their provider within the 30 day application or reevaluation period, DTA must with a self-declaration of disability and follow up with the client to get the form filled out later.  

Here is a copy of the form: https://www.mass.gov/lists/eaedc-medical-provider-statement