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Attending Physician Statement (APS) Short Term Disability Application Dear Claimant: There are two parts to this form: 1) (Claimant Information and Authorization to Release Information) is to be completed
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How to fill out attending physician statement short
01
Gather all necessary information about the patient.
02
Fill out the patient's personal information accurately, including name, date of birth, and contact details.
03
Provide details about the patient's medical condition and treatment received.
04
Include the dates of treatment and the attending physician's professional opinion on the patient's current health status.
05
Sign and date the form to certify the information provided.
Who needs attending physician statement short?
01
Insurance companies may require an attending physician statement short when processing claims.
02
Employers may request this form from employees who need medical leave or accommodations.
03
Government agencies may use this form to assess an individual's eligibility for disability benefits.
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