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  • Attending Physician Statement Form

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Marijuana used medically may mitigate the symptoms or effects of this patient s condition. This is not a prescription for the use of medical marijuana. PHYSICIAN S SIGNATURE DATE MAIL ATTENDING PHYSICIAN S STATEMENT TO APS 2008 DHS/OMMP PO Box 14450 Portland OR 97293-0450. Print Form ATTENDING PHYSICIAN S STATEMENT Oregon Medical Marijuana Program Instructions Please complete all sections of this form in order to comply with the registration requirements of the Oregon Medical Marijuana Act OR provide relevant portions of the patient s medical record containing all information required on this form* This does not constitute a prescription for marijuana* If you need this document in an alternate format please call 971 673-1234 PLEASE TYPE OR PRINT LEGIBLY. A PATIENT INFORMATION PATIENT NAME LAST FIRST M. I. DATE OF BIRTH MAILING ADDRESS TELEPHONE CITY STATE AND ZIP CODE B PHYSICIAN INFORMATION PHYSICIAN NAME C PHYSICIAN S STATEMENT Debilitating Medical Condition Check appropriate boxes. ....

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How to fill out the Attending Physician Statement Form online

Completing the Attending Physician Statement Form is an essential step in registering for the Oregon Medical Marijuana Program. This guide provides clear, step-by-step instructions to assist you in filling out the form accurately and efficiently online.

Follow the steps to complete the form online.

  1. Click ‘Get Form’ button to obtain the Attending Physician Statement Form and open it in the editing interface.
  2. Begin by filling in the patient information section. Enter the patient's name, date of birth, mailing address, telephone number, and the city, state, and ZIP code.
  3. Next, complete the physician information section. Provide your name, mailing address, telephone number, and the city, state, and ZIP code.
  4. In the physician’s statement section, indicate the patient’s debilitating medical condition by checking the appropriate boxes from the provided list of conditions.
  5. If applicable, check any additional symptoms that the patient is experiencing related to their medical condition in the designated section.
  6. Add any necessary comments or notes regarding the patient's condition and the potential benefit of medical marijuana in the comments field.
  7. Review the declaration statement confirming your licensure and responsibility for the patient's care. Provide your signature and the date.
  8. Finally, save your changes to the form, download a copy if needed, or print the completed document to share it with the relevant authorities.

Complete your Attending Physician Statement Form online today to ensure timely registration for the Oregon Medical Marijuana Program.

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Filling out an attending physician statement form involves several straightforward steps. First, the physician should gather relevant patient information, including medical history and current health status. Next, they will need to answer specific questions clearly and accurately in the form. Using resources from US Legal Forms can simplify this process and ensure that the attending physician statement is filled out correctly and efficiently.

An attending physician's statement is completed by the healthcare provider responsible for the patient's care. This individual can include family doctors, specialists, or hospital staff. They ensure that the information on the Attending Physician Statement Form is accurate and provides a clear picture of the patient's health.

An attending physician's statement is a formal document that provides details about a patient's medical condition. This statement is used for various purposes, such as insurance claims or disability benefits. The Attending Physician Statement Form includes crucial information that healthcare providers must certify.

An attending physician statement is typically completed by the patient's primary doctor or specialist. This healthcare professional has the most accurate and relevant information regarding your medical condition. It is crucial that the physician provides detailed answers to ensure the Attending Physician Statement Form meets all requirements.

Yes, you can print the DE 2501 form. Many states offer this form online through their official health department websites. Alternatively, you can find a printable version of the Attending Physician Statement Form on USLegalForms, which allows you to download and print it for your needs.

To obtain an Attending Physician Statement Form, you can start by requesting it directly from your healthcare provider. Healthcare institutions usually have these forms readily available. Additionally, platforms like USLegalForms offer convenient access to various medical forms, including the Attending Physician Statement Form, making it easy for you.

“The Attending Physician Statement is a summary of your health condition, written from a doctor or medical facility that either has treated or is currently treating someone that is seeking life insurance,” explains Paya Schlass, Customer Success Manager at Haven Life.

What is a Doctor's Statement? A Doctor's Statement is the same as Letter of Medical Necessity. It's a letter written by your doctor, verifying that the medication you are buying with your Healthcare FSA is for a diagnosis, treatment, or prevention of a disease.

An attending physician statement (APS) is a report by a physician, hospital or medical facility who has treated, or who is currently treating, a person seeking insurance.

You might be requested to approach your doctor to fill out the Attending Physician Statement or the carrier may send it directly.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232