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QBE INSURANCE (AUSTRALIA) LIMITED ABN 78 003 191 035 Attending Physician s Statement Any charge for this statement must be borne by the patient. Please complete all sections. Policy Number Claim Number

How to fill out attending physician s statement

How to fill out an attending physician's statement:

1. Obtain the necessary form: Start by obtaining the attending physician's statement form from the appropriate organization or insurance company. This form is typically required when filing a claim for disability benefits or requesting medical leave.
2. Provide patient information: Begin by filling out the patient's information section at the top of the form. This typically includes the patient's name, date of birth, address, contact information, and insurance details.
3. Specify the treating physician: Indicate the name, address, phone number, and specialty of the attending physician who has been treating the patient. This information is crucial for the insurance company to communicate with the physician if needed.
4. Describe the patient's medical history: Fill out the section that asks for details about the patient's medical history. Provide information about any previous or current diagnoses, treatments, surgeries, medications, and ongoing medical conditions. Include relevant dates and specify the impact of these medical issues on the patient's ability to work or perform daily activities.
5. Explain the current illness or injury: Describe the specific illness or injury for which the attending physician is completing the statement. Include the date of onset, symptoms experienced, and the severity of the condition. The physician should also outline any limitations or restrictions imposed by the illness or injury.
6. Assess the patient's functional limitations: The attending physician should evaluate and document the patient's functional limitations caused by their medical condition. This may include limitations on physical activities, cognitive abilities, emotional well-being, or the ability to carry out specific job functions.
7. Recommend treatment and prognosis: Provide details on the current treatment plan and whether any modifications are anticipated in the future. The attending physician should also provide their professional opinion regarding the patient's prognosis, including an estimation of the expected recovery time, if applicable.

Who needs an attending physician's statement?

An attending physician's statement is typically required by insurance companies, employers, or government agencies when processing disability claims, evaluating a patient's eligibility for medical leave, or determining their fitness for work. It is often requested in cases where a person's illness or injury affects their ability to perform their job or engage in regular activities.

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What is attending physician s statement?

Attending physician s statement is a document completed by a medical doctor that provides information about a patient's medical condition, treatment, and ability to work.

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?

Attending physician s statement can be filled out by the physician with accurate and detailed information about the patient's medical condition, treatment, and ability to work.

What is the purpose of attending physician s statement?

The purpose of attending physician s statement is to provide necessary medical information for insurance claims, disability evaluations, or other purposes.

What information must be reported on attending physician s statement?

The attending physician must report information such as the patient's medical diagnosis, treatment plan, prognosis, and any restrictions on work activities.