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Attending Physician Statement Complete and sign the form using BLUE or BLACK ink. Aetna Life Insurance Company P.O. Box 14560 Lexington, KY 40512-4560 1. Patient Instructions ? The Physician will

How to fill out attending physician statement

How to fill out an attending physician statement:

1. Gather the necessary information: Before filling out the attending physician statement, make sure you have all the required information at hand. This includes the patient's personal details, medical history, current diagnosis, and treatment plan.
2. Understand the purpose: An attending physician statement is typically required for insurance claims or disability applications. It provides a detailed assessment of the patient's medical condition, prognosis, and ability to perform daily activities. Understand why you are filling out the statement and what information is needed to accurately assess the patient's situation.
3. Start with patient identification: Begin by filling out the patient's personal information, such as their full name, date of birth, contact information, and any relevant identification numbers. This ensures that the attending physician statement is correctly associated with the specific individual.
4. Provide medical history: Briefly outline the patient's medical history, including any previous diagnoses, surgeries, or significant illnesses. This background information is essential for understanding the context of the current medical condition.
5. Describe the current diagnosis: Detail the patient's current diagnosis, including the specific medical condition they are experiencing. Use clear and concise language to accurately convey the nature of their illness or injury.
6. Explain the treatment plan: Describe the recommended treatment plan for the patient, including any medications, therapies, or procedures they are undergoing or are expected to undergo. Provide specifics about the schedule, duration, and potential side effects of these treatments.
7. Assess the patient's functional abilities: Evaluate the patient's ability to perform daily activities, such as mobility, self-care, and work. Include any limitations or restrictions imposed by the medical condition that may affect their functional abilities.
8. Provide a prognosis: Based on the available medical information and expertise, offer a prognosis for the patient's condition. This includes an estimation of their expected recovery or the anticipated course of their illness.
9. Sign and date the document: As the attending physician, it is crucial to sign and date the attending physician statement to validate its authenticity. Make sure your signature is legible and includes your full name, professional designation, and contact information.

Who needs attending physician statement?

1. Insurance companies: Attending physician statements are often required by insurance companies to evaluate the medical condition of a policyholder or claimant. These statements help insurers assess the level of risk, determine coverage eligibility, and establish claim settlements.
2. Disability programs: Government or private disability programs typically request attending physician statements when considering an individual's eligibility for disability benefits. These statements provide an objective assessment of the person's medical condition and its impact on their ability to work.
3. Employers: In some cases, employers may require attending physician statements as part of an employee's leave of absence request or reasonable accommodation process. These statements help employers understand the employee's medical condition and make informed decisions regarding workplace adjustments or absence management.

It is important to note that the specific requirements for an attending physician statement may vary depending on the purpose and requesting entity. Always ensure that you provide accurate and complete information in accordance with the guidelines provided by the requesting party.

For pdfFiller’s FAQs

What is attending physician statement?

An attending physician statement is a document completed by a medical professional that provides detailed information about a patient's medical condition, treatment, and prognosis.

Who is required to file attending physician statement?

The patient's attending physician or the medical facility where the patient is receiving treatment is typically required to file the attending physician statement.

How to fill out attending physician statement?

The attending physician or medical facility must provide accurate and comprehensive information about the patient's medical condition, treatment received, medications prescribed, and prognosis in the attending physician statement.

What is the purpose of attending physician statement?

The attending physician statement is used by insurance companies to assess the medical condition of a patient, determine eligibility for insurance coverage, and process claims.

What information must be reported on attending physician statement?

The attending physician statement should include details about the patient's diagnosis, medical history, current symptoms, treatment plan, medications prescribed, and any other relevant medical information.

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