Utlåtande för bilstöd
Here, you can find information on how to fill in the doctor’s statement for a patient applying for car allowance, and who is responsible for what.
What is car allowance?
Car allowance is money a patient can receive if they have a permanent disability and have major difficulties getting around on their own or using public transportation. Both adults and parents of a child with disability can receive car allowance. The patient uses the car allowance to buy or adapt a car to suit their needs.
How do I write a statement that gives Försäkringskassan the right information?
Social security sets high requirements for the medical information to ensure the right person gets the right compensation. When Försäkringskassan assesses a person’s right to car allowance, we investigate a person’s mobility problems. We therefore need information about the patient’s diagnosis, disability, and activity limitation. When we look at the medical documents, we use the DDA chain as support.
The DDA chain consists of:
- Diagnosis. Refers to the diagnosis/diagnoses that cause the impaired function.
- Disability. Refers to what function is impaired by the disease and what observations have been made.
- Activity limitation. Refers to the consequences of the diagnosis and disability.
In your doctor’s statement, you must describe the patient’s diagnosis, disabilities, and the activity limitations that these result in.
The statement must clearly indicate what is the patient’s own description and what is your observation and assessment as a doctor.
The activity limitation is to be described in such a way that it is understood that it is the result of the stated diagnosis, observations during the examination (status) and the described disability. The chain has to be coherent and the causal connection has to be reasonable.
Your role as doctor is to contribute the medical information, while Försäkringskassan performs the DDA analysis. It is important that you clearly distinguish between the problems reported by the patient and the clinical assessment of what you observed in connection with the medical examination or investigation.
Functions are the body’s various abilities, like being able to tense a muscle or focus attention on something. Disability is when a function is not as good as what is considered the range of ability.
The term disability refers to a loss or deviation in physical or mental function. The impairment has to be a demonstrable variation from what can be considered normal. For disabilities that cannot always be observed directly, e.g. mental functions, an observation of how the patient behaves can reveal these. The terms psychiatric status and observable findings include the doctor’s clinical assessment of the patient’s thought content, way of behaving, and way of expressing him/herself in the examination situation.
Activity limitation refers to the consequences that a disease or injury has for an individual’s ability to perform activities. Activity limitation must be assessed in relation to what can be expected in daily life, or for a specific work task.
The patient has problems in their musculoskeletal system that can impact body functions (the disability) in the form of e.g. muscle weakness and limitation of movement.
This type of disability can have consequences for the patient in the form of difficulties changing body position, or difficulties carrying items or walking. It is this limitation of ability to perform activities (activity limitation) that must be described at the individual level.
In addition, attempting to rate the limitation is often necessary to make the information understandable. An example of a severe activity limitation can be when the patient is only able to get up from a chair with great difficulty in order to lie down in a bed. How far the patient is able to walk, with or without an assistive device, is another example of how the limitation can be clarified.
The patient has pain, and the consequences for the patient’s cognitive functions must be described. This can be that the patient has a disability in the form of pain, difficulties concentrating, or reduced energy.
In the next step, it is important to clearly describe how the disability (e.g. pain) produces an activity limitation, and what form the activity limitation takes. This is because a disability in the form of pain, for example, does not necessarily lead to an activity limitation.
Describe the activity limitation by giving examples of how it affects the patient’s ability to perform activities in daily life or in the work life. Examples could be problems with memory, ability to concentrate, or ability to follow instructions.
Here is a description of what information Försäkringskassan requests in each field of the doctor’s statement. If you do not have enough space in any field, you can use the continuation page at the end of the form.
Keep your language simple and easy to understand. Please explain complicated medical terms so that they can be understood by both the patient and the Försäkringskassan administrator.
Important to keep in mind when filling in the doctor’s statement
You must assess whether the mobility problems will persist nine years into the future, not the diagnosis or the disability. Example: A patient’s leg was amputated. Naturally, this is a permanent condition. But, with an adjusted prosthesis and walking training, mobility problems can possibly decrease. Try to assess to what degree the difficulties will last.
Field 2: The statement is based on
Here, you enter what you based the doctor’s statement on. Fill in one or more alternative.
If the statement is based on your examination, enter the date of the latest examination.
Under point 9 “Other information”, provide your reasoning if it was not necessary to examine the patient.
Field 2a: Are there other medical investigation and documents relevant to the diagnosis?
If there are other investigations or documents relevant to the diagnoses made, you can enter them here. Examples of these are a neuropsychiatric statement, habilitation documentation, investigation from another specialist unit, or documentation from other professionals within the healthcare system.
Also indicate investigations you know were performed but you have not received information about. Please attach investigations or documents you have access to. If you do not have access to them, please let Försäkringskassan know which provider we can request them from.
Field 3: Diagnosis
Enter all diagnoses that affect functional capacity. Enter the diagnosis of greatest significance first. Also enter the diagnosis code.
Field 3a: Provide a brief description of the history of the above diagnoses
Here, you provide a brief description of when and how the disease or diseases debuted and developed up through today. Also describe any other medical history you think is important.
Försäkringskassan needs the information to understand the patient’s current difficulties. However, you do not need to report the patient’s full medical history.
Field 4: Disability
The doctor’s statement on car allowance that is attached to the application must contain information on the disability and its impact on the patient’s mobility (§ 5 of the Ordinance on Car Allowance to Persons with Disability). Here, you describe the patient’s disabilities and report physical and mental examination findings as well as observations you made during your examination.
The question about disability is divided into function areas according to the ICF classification of function condition, impairment, and health. Describe the patient’s disability under each function area. Also indicate the degree of disability, if possible.
If the patient does not have a disability within the function area or you do not consider it relevant to the application for car allowance, leave the field empty.
The results of examinations performed by another licensed healthcare professional can also be provided.
Field 5: Activity limitations
Activity limitations are difficulties performing activities, a task, or an action – what the patient is not able to do because of their condition or disability.
Enter the activity limitations that are a consequence of or can be attributed to the patient’s disabilities.
Activity limitations must be described at the individual level, i.e. how the disease or disability affects the patient’s mobility.
We do not request your assessment of the patient’s need for car allowance since that is something Försäkringskassan will investigate.
Field 5a: Does the disability affect the patient’s ability to get to and from public transportation?
Indicate whether the disability affects the patient’s ability to get to and from to and from public transportation and describe how. Also indicate what assistive devices the patient uses. You should not consider how far the patient must travel to get to and from public transportation.
Mobility problems can have physical or psychological causes.
The assessment must be based on ability with any assistive devices or attendant.
Field 5b: Does the disability affect the patient’s ability to travel using public transportation?
Indicate whether the disability affects the patient’s ability to travel using public transportation and describe how.
The difficulties can have physical or psychological causes, e.g. limitation of movement or difficulties being in a public environment due to psychological or asthma problems.
Examples of conditions that make it more difficult to travel by public transportation include
- difficulties getting on and off
- difficulties sitting
- problems with balance
- reduced ability to grip
- difficulty holding on during travel.
Examples of conditions that make it difficult for a person to be in a public environment include
- asthma and allergies
- intestinal diseases
- phobias and panic attacks
- hypersensitivity to e.g. noise or light.
The assessment must be based on ability with any assistive devices or attendant.
Field 5c: If the examination relates to a child: Does the disability affect the child’s ability to travel by public transportation when the parent is along?
This question should only be answered if the doctor’s statement relates to the applicant’s child, regardless of the child’s age.
Indicate whether the disability affects the child’s ability to travel using public transportation when the parent is along and describe how.
The assessment should be based on the child’s disability and be made in relation to whether the mobility problem is significantly greater than for families with a child of the same age.
For example, a child with a severe allergy or the like could prevent the family from using public transportation. The applies to a family with a physically disabled child who is no longer a young child.
Field 5d: How long do you judge the patient is able to move with and without an assistive device?
Indicate how far of a stretch you judge the patient is able to move both with and without an assistive device. Also indicate what you base your judgement on.
Field 6: Prognosis for the disability and activity limitations
Here you write how you judge that the patient's disability is such that the mobility possibilities are expected to last for at least 9 years.
Försäkringskassan needs the information to be able to assess whether the patient is entitled to car allowance.
Field 7: Ongoing or planned medical treatments
Indicate treatments and rehabilitation measures, such as medicines or training, that are given due to the patient’s disability. Also indicate the treatments, measures or investigations that are planned, e.g. surgery, therapy or a medicine regime.
Also indicate who is the responsible care provider and the schedule for the treatment or measure.
It is relevant for Försäkringskassan to know what treatments or measures have been prescribed to the patient as this could affect the patient’s need for car allowance.
Who does what?
In order for Försäkringskassan to assess the patient’s right to car allowance, we need medical information. The doctor fill’s in a doctor’s statement describing the patient’s disability and how it affects them.
- Ask for a doctor’s statement from the doctor.
- Apply for car allowance with Försäkringskassan.
- Send the doctor’s statement to Försäkringskassan.
- Fill in the doctor’s statement for car allowance.
- Give the doctor’s statement to the patient.
- Assess whether the patient is entitled to car allowance and pay out compensation if all of the conditions are met.