Get Aetna Gc-464 2016-2025

The Aetna GC-464 is a crucial form that allows users to document a disabled child's attending physician's statement effectively. This guide provides clear and supportive instructions to help users navigate the form with ease.

Follow the steps to complete the Aetna GC-464 efficiently.

1. Click the ‘Get Form’ button to obtain the Aetna GC-464 form and open it in the editor.
2. Complete sections 1-3 as the employee. Section 1 requires employer information including the employer's name and policy/group number as displayed on the ID card. In section 2, provide your personal details: your name, ID number, and birth date in the format MM/DD/YYYY. Section 3 requires the dependent child's information: their name and birth date in the same format.
3. For the physician's statement in sections 4-6, the attending physician must fill out the necessary details. Section 4 begins with details regarding medical and behavioral health conditions. This includes the diagnosis, the date of onset of the disability, objective findings substantiating impairment, and any additional clinical information that supports how the disability affects employment for individuals over age 18.
4. If the child has behavioral health conditions, the physician must complete section B, which includes providing the individual's IQ score and a functional assessment detailing communication ability, psychiatric symptoms, stability, treatment response, and prognosis.
5. In section C, physicians should refer to the Social Security Disability Guidelines to quantify the disability. Select the affected body system(s) and document the appropriate ‘listing’ number(s) relevant to the individual’s condition.
6. Section 5 requires the attending physician's contact information, including their name, telephone number, and address. The physician must also provide their signature and the date.
7. For section 6, list any other treating physicians or healthcare providers currently involved in the treatment of the individual’s mental or physical disability, including their contact details.
8. After completing the form, review all information for accuracy, then save changes, download, print, or share the completed Aetna GC-464 as needed.

Complete your Aetna GC-464 form online today for efficient processing.