Get Aetna Handicapped Child Attending Physicians Statement Form

Filling out the Aetna Handicapped Child Attending Physicians Statement Form online can be straightforward and helpful in providing necessary information about your dependent child’s needs. This guide will walk you through each section of the form, ensuring you understand what information is required and how to accurately complete it.

Follow the steps to effectively complete the form.

1. Click the ‘Get Form’ button to access the form. Once you have the form, open it in your preferred document editor.
2. Fill out Section 1, which includes employer information. Provide the name as shown on the insurance ID card and the policy/group number.
3. In Section 2, input the employee's information, including their name, birth date in the format MM/DD/YYYY, and the ID number.
4. Complete Section 3 with the dependent child's information. Include the child's name and birth date in the same MM/DD/YYYY format.
5. Move to Section 4, which includes the physician's statement. For a handicapped child, refer to Social Security Disability guidelines. Select the affected body system(s) and document the corresponding listing number(s) as explained.
6. In the behavioral health section, if applicable, provide the individual's IQ score and a functional assessment. This should include details regarding communication ability and psychiatric symptoms, continuing on a separate page if necessary.
7. In Section 5, enter the attending physician's contact information, including their name, telephone number, and address. Make sure the physician signs and dates the form.
8. Finally, if there are other treating physicians, complete Section 6 by listing their names, addresses, and telephone numbers.
9. Review all entries for accuracy, then save any changes made to the form. Download, print, or share the completed form as necessary.

Begin completing the Aetna Handicapped Child Attending Physicians Statement Form online today.