Get Statement Of Disability

Filling out the Statement Of Disability online can seem daunting, but with clear guidance, you can complete it efficiently. This guide provides step-by-step instructions to help you navigate the process seamlessly.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the Statement Of Disability form and open it in your chosen browser or editor.
2. In the first section, provide the name of the patient, Social Security Number, address, and date of birth. Ensure that all personal information is accurate to avoid processing delays.
3. Enter the employer's name and division, if applicable, followed by the patient's authorization for information release, including their signature and date.
4. For the attending physician section, indicate whether the patient's condition resulted from illness or injury. If pregnancy is a factor, specify the expected date of delivery.
5. Provide details about the primary and secondary diagnoses along with corresponding ICD-9 codes. List any subjective symptoms and all relevant test results, including dates and outcomes.
6. Document the treatment dates, including the first treatment for the condition, the onset of the condition, and the most recent treatment. Specify how often the patient has been seen and the date of the next office visit.
7. Indicate if the patient has been referred to another physician. If so, include the name, address, specialty, and nature of the treatment received from the referring physician.
8. Mention if any surgeries have been performed, including the date, and provide details if the patient was hospitalized, such as the corresponding dates and hospital name and address.
9. In the impairment section, describe any limitations the patient may have in various activities and provide information about their vision impairment if applicable.
10. Indicate whether the patient is competent to endorse checks and direct the use of proceeds. Also, assess any psychiatric impairments, indicating their level of function.
11. Finally, complete the attending physician's section with their name, contact details, license number, specialty, and signature along with the date signed.
12. Review the completed form for accuracy. Once all sections are filled out correctly, save your changes, and choose from the options to download, print, or share the completed Statement Of Disability.

Complete your Statement Of Disability online today for efficient claim processing.