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Colorado Bankers Life Insurance Company Attn: Claims Department 5990 Greenwood Plaza Blvd., Suite 325 Greenwood Village, CO 80111 800.367.7814 Fax: 855.777.5433 Email: Claims CBLife.com CBLife.com

How to fill out attending physician statement for

How to fill out attending physician statement for?

1. Gather all necessary information: Before filling out the attending physician statement, collect all relevant information such as the patient's full name, contact details, date of birth, insurance policy number, and any medical history or relevant medical records.
2. Understand the purpose: The attending physician statement (APS) is a document required by insurance companies to assess the applicant's health condition and determine their insurability. It provides an overview of the patient's medical history, current health status, and any treatment or medication they are undergoing.
3. Fill out the patient's information: Begin by writing the patient's full legal name, date of birth, and insurance policy number at the top of the form. Ensure accuracy when entering this information, as any errors could delay the processing of the application.
4. Medical history section: The APS typically includes a section for the attending physician to provide a comprehensive medical history of the patient. This may include details about past surgeries, chronic illnesses, major injuries, hospitalizations, and any ongoing medical conditions. Fill out this section accurately and provide as much detail as possible to give a clear picture of the patient's medical background.
5. Current health status: The attending physician statement also requires information about the patient's current health status. Describe any current medical conditions, current medications, and any treatments or therapies the patient is undergoing. Mention any recent diagnostic tests or procedures as well.
6. Special notes or limitations: If the patient has any limitations that affect their daily activities, such as physical restrictions or cognitive impairments, make sure to mention them in the attending physician statement. This information helps the insurance company assess the level of risk involved.
7. Sign and date the document: Once you have filled out all the necessary information, review the attending physician statement for accuracy and completeness. Sign and date the document, certifying that the provided information is correct to the best of your knowledge.

Who needs attending physician statement for?

1. Insurance applicants: Insurance companies require an attending physician statement as part of the underwriting process for applicants seeking life insurance, disability insurance, or critical illness coverage. This statement helps the insurance company assess the applicant's health condition and determine the risk involved in providing coverage.
2. Patients undergoing medical evaluations: In some cases, individuals undergoing medical evaluations or examinations for certain purposes, such as pre-employment screening, may be required to submit an attending physician statement. This statement helps verify the individual's health status and determine their fitness for specific roles or responsibilities.
3. Legal proceedings: Attending physician statements may also be required in legal proceedings, such as personal injury or disability claims. These statements help provide a comprehensive overview of the patient's medical history, current health status, and the impact of any injuries or illnesses on their daily life and ability to work.

In summary, filling out an attending physician statement requires gathering all necessary information, providing accurate details about the patient's medical history and current health status, and signing the document to certify the provided information. Insurance applicants, individuals undergoing medical evaluations, and those involved in legal proceedings may require attending physician statements.

For pdfFiller’s FAQs

What is attending physician statement for?

Attending physician statement is for providing medical information regarding a patient's condition and treatment.

Who is required to file attending physician statement for?

The patient or their legal representative is required to file an attending physician statement.

How to fill out attending physician statement for?

Attending physician statement can be filled out by the patient's physician with details of the patient's medical history, current condition, and treatment plan.

What is the purpose of attending physician statement for?

The purpose of attending physician statement is to provide necessary medical information for insurance claims or medical assessments.

What information must be reported on attending physician statement for?

The attending physician statement must include details of the patient's diagnosis, treatment plan, prognosis, and any other relevant medical information.

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