Guide · Medical certificate
MDPH medical certificate: preparing the appointment with your doctor
The short answer
The MDPH medical certificate (CERFA 15695) is filled in by the doctor of your choice, as an original, and is valid for 12 months. Several sections, including the effects on your daily life, are completed with your help: arrive at the appointment with your difficulties already described.
Who fills in the certificate
The MDPH medical certificate is form CERFA 15695. It is filled in by the doctor you choose, a GP or a specialist (MACSF). It must be attached as an original and be less than 12 months old when you file (Mon parcours handicap).
It must be written on the official form: a certificate on plain paper is not accepted by the MDPH. The doctor gives it to you so you can attach it to your application, in a confidential envelope.
What the certificate contains
After your identity, three questions let the doctor fill in a simplified certificate if nothing has changed since the previous one: have your health, your treatment and the effects on your daily life changed? If they have, the full certificate has eight sections:
| Section | Content |
|---|---|
| 1 | The condition behind the application |
| 2 | Its history: onset, circumstances, disabling signs and how often they occur |
| 3 | The current clinical description |
| 4 | Sensory impairments (hearing, sight), with separate parts if needed |
| 5 | Treatment and care, and their side effects |
| 6 | Effects on functioning and relationships |
| 7 | Additional remarks |
| 8 | The doctor’s details and signature |
The section that matters most: effects on daily life
Section 6 describes what you can do day to day, area by area: mobility and use of your hands, communication, self-care (washing, dressing, eating), cognition (attention, memory, orientation, behaviour), daily and household life, social and family life, work or school, and whether a carer helps you.
The doctor rates each area on a scale from A to D. That assessment is theirs. But they do not live your daily life: according to the MACSF, sections 3 to 6 are completed with the patient’s help, and the MDPH looks at the effects on daily life rather than the diagnosis alone.
How to prepare the appointment
The MACSF advises patients to describe to the doctor:
- their daily difficulties, with examples;
- the compensations already in place (equipment, help from a relative, adjustments);
- how their condition varies: describe the bad days too;
- the constraints and side effects of treatment.
The Centre Ressources Autisme guide adds two reflexes: tell the doctor whether it is a first certificate or a renewal, and bring existing assessments.
Appointments are short. Arriving with a written summary that follows the order of the sections helps the doctor fill in the certificate more faithfully. The summary describes your life; it never replaces the doctor’s own assessment.
If your doctor struggles to fill it in
Page 4 of the application form has a box for this: “I had difficulty getting my medical certificate filled in by the doctor”, with space for details. Use it if you could not get a complete certificate.
Printable checklist
To bring to the appointment
Arrive with a clear summary for your doctor
DossierMalin helps you describe your daily life in the order of the certificate’s sections, in English, and gives your doctor a French summary. It never fills in the certificate for them.