SECTION 1. Chapter 6A of the General Laws is hereby amended by inserting after section 18D the following section:-

Section 18D½. (a) The department shall create, in consultation with organizations representing the mobility, hearing, speech and sight impaired communities, and publish on its website a statewide disability indicator form which a person may complete and submit to the department to notify primary and regional PSAP of certain disabilities. The disability indicator form shall be available to subscribers of a wireless carrier, a wireline carrier or a prepaid wireless telephone service. The disability indicator form shall be written in clear language that is comprehensible to a person proficient in English at the fifth grade level and accessible to persons with visual disabilities. In any place, where 5 per cent of citizens of the commonwealth speak a language other than English as determined by the most recent American Community Survey of the United States Census Bureau, the disability indicator form shall be translated into that language.

The disability indicator form shall include space for the person to identify any mental health needs, intellectual and developmental disabilities, complex medical needs or neurological impairments, including, but not limited to: (i) the person has equipment required to sustain the person’s life; (ii) the person is bedridden, a wheelchair user or has another mobility impairment; (iii) the person is legally blind; (iv) the person is deaf or hard of hearing; (v) communication via the phone may be by TTY; (vi) the person has a speech impairment; (vii) the person is cognitively impaired; (viii) the person has a service animal; (ix) the person requires translation services; or (x) any potential triggers for first responders to be aware of. The disability indicator form shall also include a space for a person to remove or change any disability indicators.

(b) The department, in consultation with organizations representing the mobility, hearing, speech and sight impaired communities, shall annually review the contents of the disability indicator form and amend the disability indicator form when needed, as determined by the department.