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REQ069 (R1012) REQ069 10/22/12 2:56 PM Page 1 ATTENDING PHYSICIANS STATEMENT Physicians Name Number & Street City & State Zip Code Dear Doctor: High mark Blue Cross Blue Shield Delaware (High mark

How to fill out attending physicians statement

How to fill out an attending physician's statement?

1. Start by gathering all necessary information about the patient, including their full name, date of birth, contact information, and any relevant medical history.
2. Begin filling out the top section of the form, which typically includes the patient's personal details, the date of the examination, and the name and contact information of the attending physician.
3. Move on to the section that asks for the patient's diagnosis and medical condition. Be sure to provide accurate and detailed information about the patient's current health status.
4. Fill out the section that requests information about the patient's treatment plan, including any medications, therapies, or procedures that have been prescribed or recommended.
5. Use the next section to document any physical or functional limitations the patient may have, along with any recommendations for accommodations or modifications that could help improve their quality of life.
6. Complete the section that asks for the physician's assessment of the patient's ability to perform various activities, such as walking, lifting, or standing for long periods.
7. If the attending physician believes the patient is unable to work or participate in certain activities due to their medical condition, provide a detailed explanation and any supporting medical evidence.
8. Finally, review the completed form for accuracy and completeness before signing and dating it.
9. Keep a copy of the filled-out attending physician's statement for your records.

Who needs an attending physician's statement?

1. Insurance companies often require an attending physician's statement when processing claims for disability benefits, workers' compensation, or medical leave.
2. Employers may request an attending physician's statement to assess an employee's fitness for work, determine the need for accommodations, or qualify for certain benefits.
3. Government agencies, such as the Social Security Administration, may require an attending physician's statement to evaluate eligibility for disability benefits.
4. Attorneys and legal professionals may request an attending physician's statement as part of a personal injury or medical malpractice case.

For pdfFiller’s FAQs

What is attending physicians statement?

Attending physicians statement is a documentation provided by a physician treating a patient, outlining the patient's current medical condition and prognosis.

Who is required to file attending physicians statement?

The patient or their legal guardian is typically required to request and file the attending physicians statement.

How to fill out attending physicians statement?

The attending physician must fill out the statement with accurate and detailed information regarding the patient's medical condition and treatment plan.

What is the purpose of attending physicians statement?

The purpose of attending physicians statement is to provide insight into the patient's medical condition for insurance claims or legal purposes.

What information must be reported on attending physicians statement?

The attending physicians statement must include patient's diagnosis, treatment plan, medication list, prognosis, and the physician's contact information.

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