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STATEMENT OF PERSONAL PHYSICIAN If I am injured on the job, I wish to be treated by my personal physician, who has treated before and who has my medical records.

How to fill out statement of personal physician

How to fill out a statement of personal physician:

1. Obtain the necessary form: The statement of personal physician is typically provided by an employer or insurance company. Request the form from the appropriate source.
2. Provide personal information: Fill in your name, contact information, and any other requested personal details accurately. This is crucial for identification purposes.
3. Include medical history: Describe any relevant medical conditions or illnesses you have experienced in the past. Be specific and include relevant dates and details to give a comprehensive overview.
4. State current medical conditions: List any existing medical conditions or ongoing treatments that you are currently receiving. Provide detailed descriptions of the conditions and any medications or therapies being used.
5. Mention past surgeries or hospitalizations: Indicate any surgeries or hospitalizations you have undergone in the past. Include the dates, reasons for the procedures, and any post-operative care received.
6. Summarize medications: Include a complete list of all medications you are currently taking, including prescription medications, over-the-counter drugs, vitamins, and supplements. Specify the dosage and frequency of each medication.
7. Provide contact information of the personal physician: Include the full name, address, phone number, and other relevant contact details of your personal physician. Ensure this information is accurate and up to date for effective communication.
8. Sign and date the statement: Review the completed document to ensure all sections are filled out accurately. Sign and date the statement to confirm its authenticity and reliability.

Who needs a statement of personal physician?

1. Employers: Some employers may require a statement of personal physician as part of the hiring process or when determining an employee's eligibility for certain benefits, accommodations, or medical leaves.
2. Insurance companies: When applying for specific insurance policies or claiming certain benefits, insurance companies may request a statement of personal physician to assess an individual's medical condition and determine coverage or approval.
3. Educational institutions: Some academic institutions, particularly those offering specialized programs or activities, may require a statement of personal physician to ensure the health and safety of their students. This could be necessary for participation in sports, certain courses, or study abroad programs, for example.
4. Government authorities: When applying for certain permits, licenses, or disability benefits, government agencies may require a statement of personal physician to evaluate an individual's medical fitness or eligibility.
5. Legal proceedings: In some legal cases, such as personal injury claims or disability claims, a statement of personal physician may be requested to provide evidence or support for the claimant's medical condition or injuries.

Overall, a statement of personal physician serves as a formal document that provides relevant medical information about an individual's health status for various purposes.

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What is statement of personal physician?

The statement of personal physician is a document provided by an individual's personal physician that includes an assessment of the individual's medical condition.

Who is required to file statement of personal physician?

Individuals who are applying for certain benefits or accommodations may be required to file a statement of personal physician.

How to fill out statement of personal physician?

The statement of personal physician is typically filled out by the individual's physician and may require information about the individual's medical history, current medications, and any limitations or accommodations that may be necessary.

What is the purpose of statement of personal physician?

The purpose of the statement of personal physician is to provide information about an individual's medical condition to support a request for benefits or accommodations.

What information must be reported on statement of personal physician?

The statement of personal physician may include details about the individual's medical history, current symptoms, treatment plan, and any limitations or accommodations needed.