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Health Risk Services Inc. Providing Your Innovative Benefits Solutions HRS004A Attending Physicians Supplementary Statement SD6 Page 1×2 Part 1: Physicians Authorization Patients Name: Occupation

How to fill out attending physicians supplementary statement

Attending physicians supplementary statement is required in certain situations where additional medical information is needed for an insurance claim or a disability application. It is typically used to provide detailed information about a person's medical condition, treatment, and prognosis. Here's how you can fill out the attending physicians supplementary statement:

1. Start by downloading or requesting the attending physicians supplementary statement form from the relevant organization or institution. Make sure you are using the most up-to-date version of the form.
2. Begin by filling out the top section of the form, which usually includes personal information such as the patient's name, date of birth, contact information, and policy or claim number. Provide accurate and complete information to avoid any delays or complications.
3. In the following sections, you will be required to provide detailed information about the patient's medical history, current condition, and any treatments received. It is essential to be thorough and provide as much relevant information as possible.
4. Provide a comprehensive overview of the diagnosis and medical condition. Include details about when the condition was diagnosed, any symptoms experienced, and any relevant medical tests or laboratory results conducted. This section should accurately represent the patient's condition and should be supported by medical records or test results, when possible.
5. Describe the treatment plan and any procedures or surgeries that have been undertaken. Include information about medications prescribed, therapy sessions, rehabilitation programs, or any other treatment options utilized. Be sure to mention any changes in the treatment plan or any anticipated changes in the future.
6. Mention any anticipated prognosis or expected outcomes. Explain the impact of the medical condition on the patient's ability to perform daily activities, work, or engage in normal social interactions. Use clear and concise language to describe the disability or limitations caused by the condition.
7. Sign and date the form as an attending physician, certifying that the information provided is accurate to the best of your knowledge. Include your contact information in case the insurer or organization needs to reach you for further clarification.

Who needs attending physicians supplementary statement?

The attending physicians supplementary statement is typically needed by individuals applying for disability benefits, long-term care insurance, personal injury claims, or workers' compensation. Medical professionals who have directly treated the patient, such as attending physicians, specialists, or surgeons, are usually responsible for completing this statement.

Remember, it is crucial to include all relevant and accurate information in the attending physicians supplementary statement to ensure a comprehensive evaluation of the patient's medical condition and treatment plan.

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What is attending physicians supplementary statement?

Attending physicians supplementary statement is a form that provides additional medical information about a patient's condition and treatment.

Who is required to file attending physicians supplementary statement?

The attending physician who is responsible for the care of the patient is required to file the attending physicians supplementary statement.

How to fill out attending physicians supplementary statement?

The attending physician must complete the form with accurate medical information about the patient's condition, treatment, and progress.

What is the purpose of attending physicians supplementary statement?

The purpose of the attending physicians supplementary statement is to provide additional medical details to supplement the original medical report.

What information must be reported on attending physicians supplementary statement?

The attending physicians supplementary statement must include information on the patient's diagnosis, treatment plan, progress, and any complications.