Get the free Attending Physician's Supplementary Report

This form is used to make progress reports and final reports for injured workers under the Longshore and Harbor Workers' Compensation Act.

How to fill out attending physicians supplementary report

How to fill out Attending Physician's Supplementary Report

1. Begin with the patient's information: Name, date of birth, and identification number.
2. Fill out the date the report is being completed.
3. Provide details of the physician: Name, address, and contact information.
4. Indicate the patient's diagnosis and relevant medical history.
5. Document the current treatment plan and any medications the patient is taking.
6. Specify any limitations or restrictions for the patient’s activities.
7. Include dates of any previous treatments or surgeries related to the condition.
8. Ensure that all sections are completed accurately and legibly.
9. Sign and date the report at the bottom to validate the information.

Who needs Attending Physician's Supplementary Report?

1. Patients who are applying for disability benefits.
2. Insurance companies requiring detailed medical information for claims.
3. Employers needing information for workers' compensation claims.
4. Legal entities involved in personal injury cases.

People Also Ask about

What would an attending physician's statement be appropriate for?

Attending Physician's Statement in Health Insurance Its primary purpose is to assist in the underwriting process, which involves evaluating the risk of insuring an applicant. Among the options provided, the most appropriate response is: At the request of the insurer to assist in the underwriting decision.

What is attending physician statement report?

An attending physician statement (APS) is a report by a physician, hospital, or medical facility that has treated, or 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 an attending physician report?

An attending physician statement (APS) is a report by a physician, hospital, or medical facility that has treated, or 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 a supplemental report medical?

In the California Workers' Compensation system, a supplemental report is simply a report requested without an in-person evaluation. By definition, it must be requested only after an applicant has been initially evaluated by that QME.

What information is typically included in an attending physician's statement for disability insurance?

An attending physician statement is a form your physician must fill out. It comes in the form of a questionnaire. It will ask questions about your conditions and symptoms and how they impact your ability to work. You may come across other names for this form, such as a “functional report.”

What does CA 20 mean?

0:04 1:51 And upon completion must of your most recent examination or treatment by the physician. There isMoreAnd upon completion must of your most recent examination or treatment by the physician. There is also a CA 20 a which is the physician supplemental.

What is the difference between an attending physician and a regular physician?

Defining the Responsibilities and Authority Understanding the roles of attending physicians and resident doctors is essential in navigating the healthcare system. Attendings are fully licensed doctors responsible for overseeing the care team, while residents are physicians in training working under their supervision.

For pdfFiller’s FAQs

What is Attending Physician's Supplementary Report?

Attending Physician's Supplementary Report is a document that provides additional information and insights from the patient's attending physician regarding a patient's medical condition, treatment, and prognosis, often used in insurance claims or legal cases.

Who is required to file Attending Physician's Supplementary Report?

Typically, the attending physician who has treated the patient and is familiar with their medical history and current condition is required to file the Attending Physician's Supplementary Report.

How to fill out Attending Physician's Supplementary Report?

To fill out the Attending Physician's Supplementary Report, the physician should provide detailed information about the patient's diagnosis, treatment history, current status, and any other relevant medical data as required by the report form.

What is the purpose of Attending Physician's Supplementary Report?

The purpose of the Attending Physician's Supplementary Report is to ensure that accurate and comprehensive medical information is available to assist in the evaluation of the patient's case, particularly for claims processing, medical reviews, and legal purposes.

What information must be reported on Attending Physician's Supplementary Report?

The information that must be reported includes the patient's medical history, diagnosis, treatment plan, outcome of treatment, current condition, and any other pertinent medical observations or recommendations.