Get Gc-1486-26w. Accessible Pdf

Filling out the Gc-1486-26w form can be straightforward with the right guidance. This form is crucial for healthcare providers assisting patients with disability claims, allowing timely and accurate submissions to aid in claims processing.

Follow the steps to complete the Gc-1486-26w form efficiently.

1. Click the ‘Get Form’ button to access the Gc-1486-26w form. This will allow you to open the document in an accessible PDF editor.
2. Begin by filling out Section 1, which requires patient information. Ensure to enter the member's name, employer, employee ID or claim number, and the date of birth accurately.
3. Proceed to Section 2, where medical information needs to be provided. This section includes several subsections. Start with the primary diagnosis including the ICD code and the date of diagnosis, followed by any additional diagnoses and their codes.
4. Indicate the procedure codes and dates relevant to the treatment. You will also need to specify when you first treated the patient for this condition and confirm if you are still treating them.
5. Fill in the dates for the last office visit and the next scheduled office visit. Additionally, provide the date when you believe the impairment limited the patient’s work capacity.
6. Answer whether the patient was recently hospitalized, including details like admit and discharge dates, and the hospital's name and location.
7. Clarify if the condition is work-related and describe any limitations the patient experiences, as well as activities they can still perform.
8. Outline the patient's treatment plan, detailing any medications prescribed. Provide an estimated timeframe for full recovery and when you expect to see improvements in functional abilities.
9. Finally, complete Section 3, which requires your signature as the provider. Include your printed name, degree, specialty, contact information, and the date.
10. Once all sections are filled out, review the form for errors and ensure clarity. Save your changes, then proceed to download, print, or share the completed form as necessary.

Complete the Gc-1486-26w form online today and streamline your patient's disability claim process.