What the DS2444B is for
The Disability Income Assistance (DIA) application is one application for two programs. AISH is for adults whose severe disability permanently prevents employment. ADAP is for adults whose severe disability substantially impedes employment, continuously or episodically. The ministry decides medical, financial, age and residency eligibility. Your report tells it how the condition affects physical, mental and cognitive functioning, what treatment has been tried, and whether the condition is likely to last. The older “AISH Application, Medical Report” was replaced by this DIA version, so use the current form from alberta.ca.
Who completes it
A physician registered with the CPSA or a nurse practitioner registered with the CRNA completes and signs it, with help from specialists or allied health professionals if useful. The applicant completes a separate DIA application, online or on paper. You are responsible under the Health Information Act for getting the patient’s consent to disclose their health information.
How to fill in the medical report
Relationship with Applicant
Confirm your registration and discipline, how long you have treated the applicant, the last visit date and how often you see them. A short or occasional treating relationship is fine, but say so and attach reports from those who know the patient better.
Diagnosis(es) and Medical History
List primary, secondary and tertiary diagnoses with dates of onset and the DIA medical code or DSM code from the chart on the form. Describe each diagnosis and the symptoms it causes. Give the history in order, including progression. Record specialist referrals with dates last seen, other supporting evidence and hospital admissions, and tick whether reports are attached. Attach the relevant reports, not the whole chart.
Degree of Impairment
Rate each activity of daily living from 0 (no limitation) to 3 (severe), or DK if you don’t know. The activities cover mobility, cognitive function, personal care, independent living skills and social function. Then rate mental and emotional symptoms, thought and perception, cognition, behaviour, physical symptoms and safety, and describe how the symptoms add up to the cumulative impairment. The guide accepts that you rarely watch patients lift, climb stairs or dress, and lets you draw on consultants’ assessments.
Remedial Therapy
List medications with start date, dose, purpose and effect on functioning, or attach a list. Describe past treatment and results, the current plan and how often it is reviewed, whether the applicant follows the plan, and any further treatment expected with a timeframe. If nothing has been tried, say why.
Prognosis
Choose temporary, episodic, permanent or undetermined. Give an estimated duration for temporary conditions, and the frequency, length and severity of episodes for episodic ones. This answer matters because AISH turns on permanence and ADAP accepts episodic impairment.
Certification
Print your name, registration number and office contact details, sign and date. An unsigned report, or one without a registration number, is returned to your office.
Common reasons it’s sent back
- Unsigned, or missing the registration number or contact information.
- Signed by a professional the program doesn’t accept, such as a psychologist alone.
- Diagnoses without codes, dates of onset or the symptoms they cause.
- Activity ratings with no description of how symptoms limit function.
- No supporting reports, so the ministry can’t verify the diagnosis.
Submitting and who pays
Email the report and supporting documents to ApplyDIA@gov.ab.ca, fax them to 587-469-3006 in the Edmonton area or 1-877-969-3006 elsewhere, mail them to PO Box 17000 Station Main, Edmonton, or give them to the applicant to submit. Keep a copy and give one to the patient. The applicant pays the fee, set as the 03.04A examination equivalent plus the AMA-agreed report fee, unless the government sends an expense approval letter.