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Attending Physician Statement Complete and sign the form using BLUE or BLACK ink. Aetna Life Insurance Company P.O. Box 14560 Lexington, KY 40512-4560 1. Patient Instructions The Physician will complete

How to fill out attending physician statement

How to fill out attending physician statement:

1. Start by obtaining the attending physician statement form from your insurance company or employer. This form may also be called a medical report or a medical certificate.
2. Review the form carefully to understand the information requested. It typically includes personal information such as your name, date of birth, and contact details.
3. Fill in the details of the physician who has been providing you with medical care. Include their name, address, phone number, and any other relevant contact information.
4. Provide a detailed medical history, including the dates of your diagnosis, any treatments received, and any medications you are currently taking. Be as specific as possible to ensure accuracy.
5. Describe the nature of your medical condition, including any limitations or disabilities it has caused. Include information about how your condition affects your ability to work or carry out daily activities.
6. If applicable, provide information about any ongoing medical treatment you are receiving for your condition, including the dates of appointments and the names of healthcare providers involved.
7. Sign and date the attending physician statement form. This verifies that the information provided is accurate and complete.
8. Submit the completed form to the appropriate party, such as your insurance company or employer, as instructed. Keep a copy for your records.

Who needs attending physician statement?

1. Individuals who are applying for disability benefits or insurance claims may be required to provide an attending physician statement. This document helps insurance companies or employers assess the individual's medical condition and its impact on their ability to work.
2. People who have experienced a workplace injury and are seeking compensation may also need an attending physician statement. This document helps determine the extent of the injury and the individual's ability to return to work.
3. Some educational institutions or programs may also request an attending physician statement to assess an individual's medical condition and accommodations needed, such as for students with disabilities.

Remember to consult the specific requirements and instructions provided by your insurance company, employer, or institution when filling out an attending physician statement.

For pdfFiller’s FAQs

What is attending physician statement?

An attending physician statement is a document completed by a medical professional that provides information about a patient's medical history, current condition, and treatment plan.

Who is required to file attending physician statement?

Patients or policyholders who are making a claim for insurance benefits typically required to file an attending physician statement.

How to fill out attending physician statement?

Attending physician statement should be filled out by the patient's primary care physician or specialist, providing accurate and detailed information about the patient's medical status.

What is the purpose of attending physician statement?

The purpose of an attending physician statement is to help insurance companies assess the validity of claims and ensure that the patient is receiving appropriate medical care.

What information must be reported on attending physician statement?

Information such as medical history, diagnosis, treatment plan, prognosis, and any medical tests or procedures conducted must be reported on an attending physician statement.

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