231 Pa. Code Rule 1910.29
(b) Documentary Evidence.
(1) The court shall admit into evidence statements contained in a verified petition, affidavit, document, or a document incorporated by reference that would not be excluded under the hearsay rule if the declarant testified in person, when:
(c) Medical Evidence.
(2) Conference.
(i) A conference officer may consider a party’s medical condition if:
(3) Record Hearing.
(d) Advanced Practice Provider’s Statement Form. The Advanced Practice Provider’s Statement Form shall be substantially in the following form:
IN THE COURT OF COMMON PLEAS
OF
COUNTY
Member Name:
Docket Number:
PACSES Case Number:
Other State ID Number:
TO BE COMPLETED BY AN ADVANCED PRACTICE PROVIDER
Provider’s name:
Provider’s license number:
Provider’s title (MD, DO, etc.)
Nature of patient’s sickness or injury:
Date of first treatment:
Date of most recent treatment:
Frequency of treatments:
Medications:
Due to the patient’s medical condition, the patient can engage in the following types of work-related activity (mark all that apply):
Very heavy activity involving lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more, and the ability to perform heavy, medium, light, and sedentary activity.
Heavy activity involving lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds, and the ability to perform medium, light, and sedentary activity.
Medium activity involving lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pound do sedentary, and the ability to perform light and sedentary activity.
Light activity involving lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds, a good deal of walking or standing, or sitting with some pushing and pulling of arm or leg controls.
Sedentary activity involving lifting no more than 10 pounds at a time, occasionally lifting or carrying articles like docket files, ledgers, and small tools, sitting, and occasionally walking and standing.
None. Based on my assessment, I found that the patient’s condition is such that he or she cannot engage in any type of work-related activity.
Please mark whether the patient’s condition is
temporary or permanent.
If the patient cannot engage in any type of work-related activity and the patient’s condition is temporary, when should the patient be able to engage in any type of work-related activity
Will there be limitations?
Additional Remarks:
Signature of Treating Provider:
Date:
Provider’s address:
Provider’s telephone number:
I authorize my provider to release the above information to the
County Domestic Relations Section.
Patient’s signature:
Date:
Comment:
This rule is based on 23 Pa.C.S. § 4342(f). The rule is not intended to affect 23 Pa.C.S. § 4342(g)-(h), relating to the admissibility of payment records, billing statements, and bills for genetic testing and prenatal and postnatal health care of the mother and child. Those documents are admissible into evidence without advance notice for the limited purposes set forth in the statute.
Historical Commentary
The following commentary is historical in nature and represents statements of the Committee at the time of rulemaking:
Explanatory Comment—2000
23 Pa.C.S. § 4342(f) creates a hearsay exception in support actions to permit a verified petition, affidavit or document and a document incorporated by reference in any of them to be admitted into evidence if it would not otherwise be excluded as hearsay if given in person and it is admitted under oath by a party or witness to the support action. Rule 1910.29 requires that notice of the documents to be admitted be given to the other party prior to the hearing. It also sets forth the procedures for raising an objection to the admission of those documents.
If the requisite 20-day notice is given and there is no objection, the document must be admitted into evidence under this rule and 23 Pa.C.S. § 4342(f). In the event an objection is timely made, the rules of evidence apply to determine the document’s ultimate admissibility.
Rule 1910.29 is not intended to affect 23 Pa.C.S. § 4342(g) and (h) relating to admissibility of payment records, billing statements and bills for genetic testing and prenatal and postnatal health care of the mother and child. Those documents are admissible into evidence without advance notice for the limited purposes which are expressly set forth in those statutory provisions.
The provisions of this Rule 1910.29 amended November 7, 1988, effective January 1, 1989, 18 Pa.B. 5326; amended December 2, 1994, effective March 1, 1995, 24 Pa.B. 6263; amended May 31, 2000, effective July 1, 2000, 30 Pa.B. 3155; amended November 30, 2012, effective December 30, 2012, 42 Pa.B. 7522; amended August 11, 2025, effective January 1, 2026, 55 Pa.B. 5978. Immediately preceding text appears at serial pages (365319) to (365321).