Get the free ATTENDING PHYSICIAN39S STATEMENT - Penn Treaty

Tel 800.362.0700 fax 610.965.6962 www.penntreaty.com ATTENDING PHYSICIANS STATEMENT Prompt completion of this form in its entirety will expedite our evaluation of your patients claim. Fees for completing

How to fill out attending physician39s statement

How to fill out attending physician's statement:

1. Begin by carefully reviewing the instructions and gathering all necessary information and documents.
2. Fill out the patient's personal details, including their full name, address, contact information, and insurance information, if applicable.
3. Provide a detailed description of the patient's medical condition or injury, including the diagnosis, symptoms, and any relevant medical history.
4. Specify the dates of first treatment, last treatment, and anticipated return to work or normal activities.
5. Mention the types of treatments or therapies the patient has undergone or is currently undergoing, including medications prescribed, surgeries, rehabilitation programs, etc.
6. Include any supporting medical test results or reports, such as X-rays, MRI scans, blood tests, or specialist evaluations.
7. Indicate the extent of the patient's disability or impairment, if applicable, and whether it is temporary or permanent.
8. If the attending physician believes that the patient is unable to perform their regular job duties or requires accommodations, provide details on the limitations and restrictions.
9. Sign and date the attending physician's statement, ensuring it is legible and authenticated.
10. Submit the completed form to the appropriate entity, such as the patient's employer, insurance company, or disability program.

Who needs attending physician's statement:

1. Individuals who have experienced an illness, injury, or disability and require medical documentation to support their claims for insurance benefits, disability benefits, or medical leave.
2. Employers or insurance companies that require proof of a patient's medical condition or incapacity in relation to an employment or insurance claim.
3. Government agencies or programs that assess eligibility for disability benefits or medical assistance based on a person's medical condition.

Please note that specific requirements for filling out an attending physician's statement may vary depending on the purpose and the organization or entity requesting it. It is always essential to follow the given instructions and provide accurate and comprehensive information.

For pdfFiller’s FAQs

What is attending physician's statement?

Attending physician's statement is a medical evaluation form completed by a medical professional to provide information about a patient's medical condition and treatment.

Who is required to file attending physician's statement?

The patient or their authorized representative is typically required to file the attending physician's statement.

How to fill out attending physician's statement?

Attending physician's statement can be filled out by the patient's doctor or healthcare provider. They should include details about the patient's medical condition, treatment, and prognosis.

What is the purpose of attending physician's statement?

The purpose of attending physician's statement is to provide accurate and detailed information about a patient's medical status for insurance or legal purposes.

What information must be reported on attending physician's statement?

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

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