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Get Aenta Gc-1638-26 2012-2025
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How to fill out the Aenta GC-1638-26 online
This guide provides clear instructions for completing the Aenta GC-1638-26 form online. Whether you are familiar with digital document management or new to the process, this step-by-step overview will help you navigate each section of the form with confidence.
Follow the steps to accurately complete the Aenta GC-1638-26 online.
- Click the ‘Get Form’ button to access the Aenta GC-1638-26 form. This will open the document in your preferred editor for filling out.
- Begin with Section 1: Patient Information. Fill in the patient’s name, year of birth, claim number, employer name, and job title. Ensuring these details are accurate is essential for claim processing.
- Proceed to Section 2: Dates of Disability. Indicate the dates during which the patient was unable to work, whether the condition is work-related, and provide the expected return to work date. Make sure to provide the necessary dates clearly.
- In Section 3, outline any restrictions and limitations regarding the patient’s ability to perform modified or full duty work. Specify details like the duration of sitting, standing, or walking and any lifting requirements.
- Section 4 requires you to list the patient's diagnosis, including primary and secondary medical conditions along with the corresponding ICD-9 codes.
- In Section 5, address the surgery and treatment details. If the patient has been hospitalized, indicate dates of admission and discharge, along with treatment summaries and related medication information.
- Finalize the form in Section 6 by providing the physician's signature, along with their name, phone number, specialty, and address. Ensure that all information is accurate and legible.
- Once you have completed all sections, review the information for accuracy. After confirming that all necessary fields are filled, save your completed form. You can then proceed to download, print, or share the document as needed.
Complete your Aenta GC-1638-26 form online today for efficient processing.
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