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ATTENDING PHYSICIAN S STATEMENT Group/Policy # Return to: Life & Disability Claims P.O. Box 83149 Lancaster, PA 17608-3149 (717) 397-2751 or (800) 233-0307 Failure to answer all questions properly
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How to fill out attending physician39s statement
How to fill out an attending physician's statement:
01
Make sure to provide accurate personal information, including your name, date of birth, contact information, and policy or claim number if applicable.
02
Indicate the purpose of the statement, such as for insurance claim or medical evaluation.
03
Describe your medical condition or injury in detail, including the dates of diagnosis, symptoms experienced, treatments received, and any ongoing or future treatment recommendations.
04
Include information about your medical history, such as pre-existing conditions, previous surgeries, and medications taken.
05
Provide a detailed account of your limitations or disabilities caused by the medical condition or injury, including how it affects your daily activities, work capacity, and any necessary accommodations.
06
If applicable, attach relevant medical records, test results, or imaging studies that support your statement.
07
Sign and date the attending physician's statement, including your healthcare provider's contact information and professional credentials.
Who needs an attending physician's statement:
01
Individuals who are filing an insurance claim for disability benefits or accident compensation may be required to submit an attending physician's statement. This helps insurance companies or legal entities assess the legitimacy of the claim and determine the appropriate coverage or compensation.
02
Employees who are seeking medical leave or workplace accommodations due to a medical condition may need to provide an attending physician's statement to their employer or human resources department.
03
Students who require academic accommodations for medical reasons may be asked to provide an attending physician's statement to their educational institution's disability services office.
In general, anyone requiring medical documentation to support their claim, request, or application may need an attending physician's statement. It is important to check the specific requirements of the organization or institution you are dealing with to ensure you provide the necessary documentation.
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What is attending physician's statement?
Attending physician's statement is a medical form completed by a patient's doctor to provide information about the patient's current medical condition.
Who is required to file attending physician's statement?
The patient's attending physician is required to file the attending physician's statement.
How to fill out attending physician's statement?
The attending physician must provide accurate and detailed information about the patient's medical condition, treatment plan, and prognosis.
What is the purpose of attending physician's statement?
The purpose of the attending physician's statement is to provide the insurer or other relevant parties with medical information about the patient.
What information must be reported on attending physician's statement?
The attending physician must report the patient's diagnosis, treatment plan, prognosis, and any limitations on the patient's activities.
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