Get Gp9725 50 Attending Physicians Form

Filling out the Gp9725 50 Attending Physicians Form online can be a straightforward process when following the right steps. This guide is designed to help users understand each section of the form, ensuring that all necessary information is submitted accurately and completely.

Follow the steps to successfully complete the form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by completing the employer statement section. Fill in the type and amount of benefits being claimed, including life coverage, short term disability, and long term disability. Provide the employer’s name, employee’s name, and identification number.
3. Proceed with the employee's details. Include their address, phone number, job title, date of employment, and effective date of coverage. Don't forget to attach the employee's job description.
4. Indicate the reason the employee stopped working by selecting one from the provided options: illness, injury, or other. Also, confirm whether the coverage was in force when the disability began.
5. Fill in the questions regarding the employee's return to work status and any Worker’s Compensation information, if applicable. This includes the name and address of the Worker’s Compensation carrier.
6. Provide details about the employee's salary and any additional income sources they may have, including State Disability Income, pension benefits, and other types of income. Specify the amount received and the frequency of payments.
7. Complete the employee statement section, which includes personal details of the employee, other insurances held, and descriptions of their disability and occupational history.
8. Have the attending physician complete their section. This includes the patient's medical details and the physician’s opinion on the patient’s ability to work.
9. Ensure the authorization for release of personal health and other information is signed by the claimant.
10. Once all sections are filled out, review the entire form for accuracy. Save your changes and then download, print, or share the completed form as required.

Complete your documents online easily and accurately.