Get the free Attending physician39s statement general - Alberta Blue Cross

ATTENDING PHYSICIANS STATEMENT GENERAL 10009108 Street NW, Edmonton, Alberta T5J 3C5 PHONE: (780) 4988100 or 18002321914 Faxes: 7804412605 or 7804985991 Toll free FAX: 18556602605 INSTRUCTIONS: 1.

How to fill out attending physician39s statement general

How to fill out an attending physician's statement general:

1. Obtain the form: Start by obtaining the attending physician's statement general form from the appropriate source, such as your employer, insurance company, or healthcare provider.
2. Read instructions: Carefully read the instructions provided with the form. Make sure you understand the purpose of the form and the information required.
3. Personal information: Begin by filling out your personal information accurately and completely. This may include your name, contact details, date of birth, social security number, and any other information requested.
4. Medical condition information: Provide detailed information about your medical condition for which you are seeking this statement. Be specific about the diagnosis, symptoms, and any treatments received. Include relevant dates and medical history, if necessary.
5. Current treatment: Describe your current treatment plan, including medications, therapies, and any upcoming or ongoing procedures. If you have multiple healthcare providers involved in your treatment, provide their names and contact information.
6. Functional limitations: Explain any functional limitations or restrictions caused by your medical condition. This may include limitations in activities of daily living, mobility, or work-related activities. Be descriptive and provide examples, if possible.
7. Prognosis: Provide an assessment of your expected prognosis based on your medical condition. Mention any expected improvements or deterioration in your health.
8. Physician's certification: The attending physician should sign and certify the statement, indicating that the information provided is accurate and true to the best of their knowledge.

Who needs an attending physician's statement general:

1. Individuals applying for disability benefits: If you are applying for disability benefits, an attending physician's statement may be required as part of the application process. This statement helps to provide medical evidence to support your claim.
2. Insurance claims: When filing insurance claims, especially for long-term disability or critical illness coverage, an attending physician's statement may be required to provide proof of your medical condition and its impact on your ability to work or perform daily activities.
3. Employers or human resources: In some cases, employers or human resources departments may request an attending physician's statement to assess an individual's fitness for work, provide workplace accommodations, or determine eligibility for certain benefits.

In conclusion, filling out an attending physician's statement general involves providing accurate and detailed information about your medical condition, current treatment, functional limitations, and prognosis. This form may be required for individuals applying for disability benefits, filing insurance claims, or for employers to assess an individual's fitness for work.

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