Get the free Attending Physician Statement - prudentialcom

Group Disability Insurance The Prudential Insurance Company of America Disability Management Services P.O. Box 13480, Philadelphia, PA 19176 Tel: 8008421718 Fax: 8778894885 www.prudential.com/forphysicians

How to fill out attending physician statement

How to fill out attending physician statement:

1. Start by carefully reviewing the form and familiarizing yourself with the information requested. This may include details about the patient's medical history, current condition, and any treatments or medications they are receiving.
2. Provide accurate and comprehensive information about the patient's diagnosis and any relevant medical conditions. Include the dates of onset, severity, and prognosis if available.
3. Document the treatments or therapies the patient is currently undergoing, including any medications prescribed and their dosage. Include any known allergies or adverse reactions to medications.
4. If the patient has undergone any surgeries or procedures, provide the dates, locations, and details of these interventions. Include the name of the surgeon or specialist involved.
5. Include any laboratory test results, imaging studies, or other diagnostic evaluations that have been conducted for the patient. Provide dates and relevant findings.
6. If the patient is disabled or unable to work, provide details about their functional limitations and restrictions. Include the date of disability and any anticipated duration.
7. Sign and date the attending physician statement, indicating that the information provided is true and accurate to the best of your knowledge.
8. Keep a copy of the completed attending physician statement for your records and provide the original to the requesting party.

Who needs attending physician statement:

1. Insurance companies often require an attending physician statement as part of the claims process. This helps the insurer assess the patient's medical condition and determine the eligibility for benefits or coverage.
2. Attorneys may also request an attending physician statement in the context of personal injury or medical malpractice cases. This statement can provide important medical evidence or expert opinion regarding the patient's condition.
3. Employers or government agencies may require an attending physician statement for employees who are requesting medical leave or disability accommodations. This statement helps determine the need for workplace accommodations or the duration of medical leave.

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