Get the free Physician's Statement (Form 1528) - Missouri Department of Revenue

Reset Form MISSOURI DEPARTMENT OF REVENUE DRIVER LICENSE BUREAU, P.O. BOX 200 301 WEST HIGH STREET, ROOM 470 JEFFERSON CITY, MO 65105-0200 Print Form TELEPHONE: (573) 751-2730 FAX: (573) 522-8174

How to fill out physician39s statement form 1528

How to fill out physician's statement form 1528:

1. Begin by writing your personal information at the top of the form. Include your full name, address, phone number, and any other required details.
2. Next, provide the name and contact information of your physician or healthcare provider. Make sure to accurately spell their name and include their office address and phone number.
3. In the following sections of the form, you will be asked to provide details about your medical history and current health condition. Answer each question honestly and to the best of your knowledge.
4. If there are any specific medical tests, treatments, or medications that are relevant to your situation, ensure to include them in the appropriate sections of the form.
5. The form may also ask for additional information regarding your ability to perform certain activities, work-related limitations, or any recommendations from your physician.
6. Ensure that all sections of the form are complete and legible. In case any sections are not applicable to your situation, leave them blank rather than providing inaccurate or false information.
7. Once you have filled out the form, carefully review it for any errors or missing information. Make any necessary corrections before submitting it.
8. Finally, sign and date the form at the bottom to certify that the information provided is true and accurate to the best of your knowledge.

Who needs physician's statement form 1528:

1. Individuals who are applying for disability benefits or insurance claims may need to fill out form 1528.
2. This form is also required for individuals seeking accommodations or medical certifications for certain activities such as driving exams, sports participation, or work-related purposes.
3. Employers or insurance companies may request this form to assess an individual's medical condition and determine the appropriate course of action.

Please note that the specific requirements and need for form 1528 may vary depending on the jurisdiction and purpose of its use. It is always advisable to consult with the relevant authorities or professionals to ensure accurate and up-to-date information.

For pdfFiller’s FAQs

What is physician's statement form 1528?

The physician's statement form 1528 is a document used to report a physician's assessment of an individual's medical condition.

Who is required to file physician's statement form 1528?

Individuals who are seeking medical approval or clearance for certain activities may be required to file physician's statement form 1528.

How to fill out physician's statement form 1528?

Physician's statement form 1528 should be filled out by a licensed physician who has conducted a medical assessment of the individual in question.

What is the purpose of physician's statement form 1528?

The purpose of physician's statement form 1528 is to provide an official medical assessment of an individual's health condition.

What information must be reported on physician's statement form 1528?

Physician's statement form 1528 must include details of the individual's medical history, current health status, and the physician's professional opinion.

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