The DE 2525XX is the Physician/Practitioner's Supplementary Certificate that California EDD uses when a patient's disability lasts longer than the period stated on the original claim. The treating physician or practitioner completes it, either on paper or online through SDI Online. On FillingPDF you can fill out the form online and download or print the completed PDF; EDD publishes the form and its guide at edd.ca.gov, and the certificate reaches EDD only through the channels described below.
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What is DE 2525XX?
The DE 2525XX, Physician/Practitioner's Supplementary Certificate, is the CA EDD form a physician or practitioner completes to support extending a patient's disability claim beyond the original period. EDD's agency page lists it as the Request for Continued Benefits – Physician/Practitioner's Supplementary Certificate.
The EDD guide titled How to Fill Out the DE 2525XX walks through the paper form page by page. The information required is:
- Treatment status and last treatment date (Question #1).
- Current condition or diagnosis (Question #2).
- Next appointment date (Question #3).
- ICD diagnosis code(s) (Question #4).
- Estimated return to work date (Question #10).
- Disclosure of information to the patient (Question #11).
The form also asks for the practitioner's license number and license type, an address that meets USPS standards, a handwritten signature and a date. The form has three pages that must be included (pages 1, 2 and 3).
EDD does not make this form available for ordinary download. It sends the paper form to the claimant with the final payment, and the physician or practitioner can instead complete the same certification online through SDI Online. It is different from the Paid Family Leave (PFL) Supplemental Claim Certification (DE 2525XFA), which EDD lists separately, and from Part B of the Claim for Disability Insurance (DI) Benefits (DE 2501), the first certification on a new claim.
Who needs to file DE 2525XX?
The physician or practitioner who treats a disability claimant completes the DE 2525XX when the claimant's disability lasts longer than the original period stated on the claim. EDD's agency page says the claimant receives the paper form with the final payment and gives it to the physician or practitioner, who can also find and file the certification online using myEDD to access SDI Online.
To file online, the provider needs:
- a valid license from the California Department of Consumer Affairs;
- a one-time registration in myEDD.
Out-of-state providers must call 1-855-342-3645 before completing registration.
Claimants who lost the form or never received it can request another one through their SDI Online account or by calling 1-800-480-3287 or 1-866-658-8846 (en español).
Do not use this form for a Paid Family Leave claim: EDD lists a separate certification, DE 2525XFA, for that. Accredited religious practitioners use their own forms, such as DE 2502, which a physician or practitioner cannot complete.
When to file DE 2525XX
Complete the DE 2525XX when the claimant's disability lasts longer than the original period stated on the claim and the claim needs to be extended. EDD sends the paper form to the claimant with the final payment, so the certification follows that payment.
The EDD guide sets no calendar deadline on the form itself. It does address late submissions: if the DE 2525XX is being submitted late, include a letter from the physician or practitioner that explains why it is late and requests a late filing exception. EDD's guide also tells providers to fill in the estimated return to work date (Question #10) with a real date, since "unknown" and "indefinite" are not accepted.
Documents you need
- Notice of Incomplete Disability Insurance Claim Form Returned to the Medical Provider (Form DE 2532): include it only if it is necessary for processing, for example when EDD returned an incomplete form.
- A letter from the physician or practitioner explaining why the DE 2525XX is being submitted late and requesting a late filing exception: needed only for a late submission.
- Other documents, such as work status reports, are not required unless EDD asks for them; attaching them or lists of authorized signatures may cause delays.
How to fill out DE 2525XX
Choose online or paper completion
Providers with a California Department of Consumer Affairs license can file through SDI Online after one-time myEDD registration. Otherwise complete the paper form the patient received; write or print clearly in black ink, one letter or number per box.
Enter treatment status and date
Question #1 requires both the treatment status and the last treatment date. Write the date in MMDDYYYY format and check one box where the form asks for a single choice.
Describe the condition or diagnosis
Question #2 asks for the current condition or diagnosis. Write one letter, number or symbol in each box and leave a box blank where there is a space.
Add the next appointment date
Question #3 asks for the next appointment date, in MMDDYYYY format. Leave the field blank if no answer applies; do not write N/A.
Enter ICD diagnosis codes
Question #4 takes ICD diagnosis codes only. Check the ICD version box so that it matches the code(s) you entered, since corrections cause delays.
List service or treatment codes
Where the form asks for codes for services or treatments performed, enter ICD or CPT codes for services or treatments performed only. Leave fields blank if there is no answer.
Give the estimated return to work date
Question #10 asks for the estimated return to work date in MMDDYYYY format. Do not use "unknown" or "indefinite".
Answer the disclosure question
Question #11 asks about disclosure of information to the patient. Check one box as the form directs.
Enter license number and license type
Write the license number with all its letters and numbers, for example NP54321, DC12345, NMW1234, REG12345 (county facility) or VA12345 (Veterans Administration). Do not use an NPI number; enter the license type, such as Nurse Practitioner (NP), Chiropractor (DC) or Nurse Midwife (NMW).
Complete address and phone
Write the address so that it meets USPS standards, using the ZIP Code lookup tool on USPS.com if needed. Do not use address labels or stamps, and leave the red area blank.
Sign, date, review and download
Sign the red line by hand with your original signature and write the date in MMDDYYYY format. Check that pages 1, 2 and 3 are all included, then download or print the completed PDF from FillingPDF and sign it before submitting through EDD's channels.
How to submit DE 2525XX
A physician or practitioner can submit the DE 2525XX online through SDI Online or on the paper form the patient receives by mail.
- SDI Online (faster, per EDD): register once at myEDD, then log in at https://myedd.edd.ca.gov/, select SDI Online, choose Register as a Physician/Practitioner, complete the ID.me verification and follow the instructions to finish registration. You need a valid license from the California Department of Consumer Affairs. Out-of-state providers call 1-855-342-3645 before completing registration. More information: https://edd.ca.gov/en/disability/Basics_for_Physicians-Practitioners/ and https://edd.ca.gov/en/disability/SDI_Online/.
- Paper: use the form that EDD mails to the claimant with the final payment. Include pages 1, 2 and 3, sign with your original handwritten signature in black ink, and add only documents needed for processing. The guide prints no mailing address; use the one on the form EDD sent. Attaching extra documents, such as work status reports or lists of authorized signatures, may cause delays.
Do not use stamps for signatures or address labels. FillingPDF lets you fill out and download the PDF; submission follows the EDD channels above.
Common mistakes to avoid
- Writing "N/A" or "not applicable" in a box; the guide says to leave a field blank if it does not apply.
- Using strikeouts, strikethroughs, correction tape or correction liquid; the guide lists them as causes of delay, and corrections cause delays.
- Entering "unknown" or "indefinite" as the estimated return to work date in Question #10.
- Writing an NPI number or a license number without its letter(s); license numbers must have all letters and numbers, such as REG12345 or VA12345.
- Using a signature stamp or address labels instead of an original handwritten signature and a handwritten address.
- Writing the date in a format other than MMDDYYYY, or using more than one character per box.
- Checking an ICD version that does not match the ICD code(s) entered in Question #4.
- Leaving out pages 1, 2 or 3; the guide says to include all three pages.
- Writing in the red area of page 4, which must stay blank, or using ink that is not black.
Frequently asked questions
What is the DE 2525XX form?
The DE 2525XX is the CA EDD Physician/Practitioner's Supplementary Certificate. A physician or practitioner completes it to support extending a disability claim when the disability lasts longer than the original period on the claim. EDD sends the paper form to the claimant with the final payment.
Who fills out the DE 2525XX?
The claimant's treating physician or practitioner completes it. The claimant receives the paper form with the final payment and gives it to the provider, who can also file the certification online through myEDD and SDI Online instead.
I lost my DE 2525XX. How do I get another one?
You can request another form through your SDI Online account or by calling 1-800-480-3287, or 1-866-658-8846 for Spanish. EDD says some forms cannot be ordered or downloaded because it sends them when needed for your claim.
Can a doctor submit the DE 2525XX online?
Yes. EDD says the online route through SDI Online is faster. The provider needs a valid license from the California Department of Consumer Affairs and a one-time myEDD registration, with ID.me verification. Out-of-state providers call 1-855-342-3645 before registering.
Can I write N/A or cross out a mistake on the DE 2525XX?
No. EDD says not to use "N/A" or "not applicable," strikeouts, strikethroughs, correction tape or correction liquid, because they cause delays. Leave a field blank if it does not apply, and write in black ink only.
What do I enter for the estimated return to work date?
Enter a specific date in MMDDYYYY format in Question #10. EDD says not to use "unknown" or "indefinite."
What if the DE 2525XX is being submitted late?
Include a letter from the physician or practitioner that explains why the DE 2525XX is late and requests a late filing exception. EDD tells providers to include only documents needed for processing.
How do I write the license number on the DE 2525XX?
Include every letter and number, such as REG12345 for a county hospital or VA12345 for a government facility. Do not use an NPI number. The form's license type examples include Nurse Practitioner (NP), Chiropractor (DC) and Nurse Midwife (NMW).
Can I fill out the DE 2525XX online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not connected to EDD, and does not submit the certificate; you sign it by hand and submit it through EDD's channels.
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