The Hartford LC-7135 2014 free printable template

HARTFORD LIFE INSURANCE COMPANY ATTENDING PHYSICIAN S STATEMENT OF DISABILITY Clear Form To be completed by the Employee Name of patient Address of patient Social Security Number Street City D.

How to fill out form hartford attending physician

How to fill out form Hartford attending physician:

1. Obtain the form: Request the form Hartford attending physician from the relevant party or download it from the official Hartford website.
2. Fill in personal information: Provide your full name, date of birth, address, and contact information in the designated fields.
3. Specify the duration: Indicate the period you expect the attending physician's services to be required, whether it is for a single consultation or an ongoing treatment.
4. Medical history and diagnosis: Briefly explain your medical condition, including any relevant past diagnoses, treatments, and medications.
5. Specify preferred physician: If you have a specific attending physician in mind, include their name, contact information, and any related details. Otherwise, leave this section blank.
6. Special requests or instructions: If there are any special requests or instructions for the attending physician, such as language preferences or accessibility accommodations, provide them in this section.
7. Sign and date: Review the completed form, ensure all information is accurate and legible, then sign and date it as required.

Who needs form Hartford attending physician?

1. Individuals requiring medical treatment: Patients who are seeking medical treatment, whether for a specific condition or ongoing care, may need to fill out the form Hartford attending physician.
2. Insurance companies: Insurance companies may request the form Hartford attending physician when processing claims related to medical treatment to verify the attending physician's information.
3. Healthcare facilities: Hospitals or clinics may require the form Hartford attending physician to ensure that patients receive appropriate care and that the attending physician is aware of the patient's medical history and treatment needs.

People Also Ask about the hartford attending physician statement

What is an Attending Physician Statement summary?

An Attending Physician Statement is a form with a series of questions that provide a summary of your health, from your physician's point of view. You do not have to pay anything for it, but it can increase the application processing time by a couple of weeks or more with your insurance company.

What is an attending physician report?

An attending physician statement (APS) is a report by a physician, hospital or medical facility who has treated, or who is currently treating, a person seeking insurance. In traditional underwriting, an APS is one of the most frequently ordered additional sources of medical background information.

What is the purpose of an Attending Physician Statement?

An APS is a summary of your medical history from your doctor. Why do I need an attending physician statement? Insurance companies may request an APS if they need to clarify details of your medical history before they make you a formal offer of coverage.

What is the purpose of an attending physician statement?

An APS is a summary of your medical history from your doctor. Why do I need an attending physician statement? Insurance companies may request an APS if they need to clarify details of your medical history before they make you a formal offer of coverage.

What does Hartford Financial Services do?

The Hartford is a leader in property and casualty insurance, group benefits and mutual funds. With more than 200 years of expertise, The Hartford is widely recognized for its service excellence, sustainability practices, trust and integrity.

What is the Hartford mission statement?

We view underwriting human achievement to be at the heart of what we do, aiming to build resilience in our communities, empower personal and business success for our customers and create a culture where our employees can thrive.

What is included in an attending physician statement?

Typically, an APS includes places to indicate diagnoses, currently prescribed medication, and the length and extent of your treatment relationship with your treating medical provider.

Why is Hartford a good company?

The Hartford is a good insurance company, as WalletHub's editors give it a rating of 3.1/5 for its top-notch claims service and wide range of insurance options. The Hartford specializes in policies for drivers age 50 and older, however, so younger drivers may want to shop elsewhere for better discounts and benefits.

What is a signed physician statement?

A physician statement contains the patient's personal information as well as the medical history including past medical conditions, treatments applied, and results. It also includes information about the current medical status and if the patient is currently under any kind of treatment or medications.

What is the purpose of a physician statement?

An APS is one of the primary ways an insurance company obtains information about the severity of your medical condition and your treatment history. The APS typically contains a series of questions for a treating medical provider to complete.

What is included in an Attending Physician Statement?

Typically, an APS includes places to indicate diagnoses, currently prescribed medication, and the length and extent of your treatment relationship with your treating medical provider.

Who is considered an attending physician?

A medical doctor who is responsible for the overall care of a patient in a hospital or clinic setting. An attending physician may also supervise and teach medical students, interns, and residents involved in the patient's care.

Who completes an attending physician's statement?

Who completes an Attending Physician Statement? In order to be effective, an Attending Physician Statement must be completed by a doctor who knows you in person — your insurer or agency will reach out to get information from a physician who has either treated you in the past or is currently providing treatment.

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How to fill out form hartford attending physician?

To fill out the Hartford Attending Physician form, follow these steps: 1. Begin by carefully reading and understanding the form's instructions. 2. Write the date of filling out the form on the designated space. 3. Provide the patient's name, date of birth, and gender in the appropriate fields. 4. Fill in the patient's address, city, state, and zip code details. 5. If applicable, include the patient's telephone number and email address. 6. Select the patient's occupation and employer if required. 7. Specify the date the patient first sought medical care for the current condition. 8. Indicate the patient's primary insurance coverage details, including the policyholder's name, group number, and policy number. 9. If there is secondary insurance coverage, provide the necessary information as requested. 10. Move on to Part 1 of the form, where the attending physician must complete their details, including their name, specialty, address, telephone number, fax number, and email address. 11. Fill out Part 2, starting with the primary diagnosis. Write down the ICD-10 code corresponding to the diagnosis. 12. List all relevant co-morbid conditions and write their corresponding ICD-10 codes as well. 13. Provide a detailed description of the patient's current medical condition, including the symptoms, medical history, and any appropriate lab or diagnostic results. Include any restrictions or limitations on the patient's activities. 14. Specify any treatments the patient is currently undergoing or has previously undergone, such as medications, therapies, surgeries, etc. 15. If the patient can no longer work due to their medical condition, indicate the date when they became disabled and answer the subsequent questions about the disability. 16. In the physician's certification section, the attending physician must sign and date the form, verifying the accuracy of the provided information. 17. If necessary, attach any supporting medical records, statements, or test results to substantiate the claims made in the form. 18. Double-check the completed form for accuracy and completeness before submitting it to the appropriate party or entity. It is important to note that the process and requirements for filling out the Hartford Attending Physician form may vary depending on the specific version or purpose of the form. It is always advisable to carefully review the form's instructions and follow any additional guidelines provided.

What is the purpose of form hartford attending physician?

The purpose of a Form Hartford Attending Physician is to provide medical professionals with a standardized format for documenting and reporting a patient's medical condition and treatment progress. This form is commonly used in workers' compensation cases to gather information and assess the extent of a worker's injury or illness, their ability to perform job duties, and the necessary treatment plan. It helps insurance companies and employers obtain accurate medical information and make informed decisions regarding compensation and rehabilitation.

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