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ATTENDING PHYSICIAN S STATEMENT P.O. Box 100102 Columbia, SC 29202-3102 FOR OFFICE USE ONLY APPROVED DATE WAIVER OF PREMIUM The Patient is responsible for the completion of this form without expense

How to fill out attending physician39s statement

How to fill out attending physician's statement:

1. Obtain the necessary form: Contact the appropriate institution or insurance company to obtain the attending physician's statement form. This form is typically required for medical claims or disability applications.
2. Personal information: Provide your personal details, including your name, address, date of birth, and contact information. You may also need to provide your insurance policy number or any other relevant identification numbers.
3. Patient information: Fill in the patient's information accurately, including their name, date of birth, and any other relevant details requested on the form. This information helps to ensure that the statement is correctly associated with the patient's medical history or claim.
4. Medical history and diagnosis: Write a detailed account of the patient's medical history, including any previous illnesses, surgeries, or injuries. Include specific dates if possible. It is important to describe the current diagnosis or condition thoroughly and provide any relevant medical test results or treatment details.
5. Treatment and medications: Document the current treatment plan or medications being prescribed to the patient. Include the names of the medications, dosages, frequency, and any other specific instructions relevant to the patient's condition. This information helps the insurance company or institution assess the medical necessity and appropriateness of the treatment.
6. Disability information: If the attending physician's statement is being filled out for a disability claim, provide details about the patient's limitations, functional restrictions, and anticipated duration of the disability. This information helps determine the patient's eligibility for disability benefits.
7. Physician's certification: The attending physician should review, sign, and date the form to certify the accuracy of the information provided. This signature confirms that the physician is the attending doctor responsible for the patient's care and that the statement is based on their professional knowledge and expertise.

Who needs attending physician's statement:

1. Insurance companies: Insurance companies often require an attending physician's statement to assess the validity of medical claims, determine coverage eligibility, or evaluate the nature and severity of a claimed injury or illness. This statement provides medical evidence from a qualified healthcare professional to support the claim.
2. Employers: Some employers may request an attending physician's statement to verify an employee's medical condition, especially if it affects their ability to perform essential job functions or requires workplace accommodations. This statement helps employers make informed decisions regarding reasonable accommodations or medical leave.
3. Government agencies: Various government agencies may require an attending physician's statement for disability benefit applications, social security claims, or workers' compensation cases. This statement helps establish medical evidence to support the individual's eligibility for necessary benefits or compensation.

In conclusion, filling out the attending physician's statement requires accurately providing personal and patient information, detailing the medical history, diagnosis, treatment, and medications, and obtaining the physician's certification. This statement is commonly needed by insurance companies, employers, and government agencies for assessment, validation, or determining eligibility in various medical and disability-related situations.

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What is attending physician's statement?

Attending physician's statement is a document completed by a patient's healthcare provider that provides medical information about the patient's condition.

Who is required to file attending physician's statement?

The patient's healthcare provider or attending physician is required to file the attending physician's statement.

How to fill out attending physician's statement?

The attending physician should fill out the statement with accurate and detailed medical information about the patient's condition, treatment, and prognosis.

What is the purpose of attending physician's statement?

The purpose of the attending physician's statement is to provide the patient's insurance company or other relevant parties with medical information needed to process claims or determine eligibility for benefits.

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

The attending physician should report the patient's diagnosis, treatment plan, prognosis, and any other relevant medical information.