Get Attending Physician Statement

Filling out the Attending Physician Statement accurately is crucial for ensuring that your medical information is conveyed effectively for insurance purposes. This guide provides clear, step-by-step instructions for completing the form online.

Follow the steps to complete your Attending Physician Statement online

1. Press the ‘Get Form’ button to obtain the Attending Physician Statement form and open it in the available online editor.
2. Start by having the patient complete Section 1 of the form. They should fill in their name at the top of Pages 2 and 3, along with their Social Security Number, date of birth, gender, home address, and employer information, along with the type of claim they are filing.
3. The physician will then fill out Sections 2 through 7 based on a recent examination. They must provide all relevant details, including the impairment diagnosis, treatment dates, and any necessary documentation.
4. In Section 3, the physician should note the nature of the disability, including the expected duration and any primary or secondary diagnoses along with their corresponding ICD codes.
5. Section 4 requires detailing the patient's history, including any similar past conditions, and whether their current condition is related to their employment.
6. For Section 5, the physician should indicate the patient's functional abilities and any limitations on their work capacity.
7. In Section 6, the physician will assess the patient's current status, including their progress and motivation to return to work.
8. Lastly, in Section 7, the attending physician must provide their information, including name, specialty, address, and contact details, and sign the form to confirm this information.
9. Once all necessary sections are completed, review the form for accuracy, then save changes, download, print, or share the completed Attending Physician Statement as needed.

Complete your Attending Physician Statement online today to ensure your insurance claims are submitted without delay.