Get Rbc 83738 2008-2026

The RBC 83738 form, also known as the attending physician supplementary statement, is an essential document required for processing claims related to patient health. This guide provides clear, step-by-step instructions on how to accurately fill out this form online, ensuring that all necessary information is provided.

Follow the steps to complete the RBC 83738 form online.

1. Click the ‘Get Form’ button to obtain the RBC 83738 form and access it in your preferred editor.
2. Fill in the patient’s information, including the last name, first name, middle name, date of birth (MM/DD/YYYY), height (in/cm), weight (lb/kg), and policy number(s). Ensure all information is accurate.
3. Proceed to the diagnosis section. Provide the primary diagnosis, indicating if it is psychiatric by including the DSM-IV details, and note any secondary diagnosis or complications. Document current symptoms that limit the patient’s ability to work, along with objective findings such as test names, dates, and results.
4. In the treatment section, state the date of the latest visit and indicate whether the patient has been hospitalized by selecting 'Yes' or 'No'. If hospitalized, list hospital names and the confinement dates.
5. Detail any surgeries related to the condition by selecting 'Yes' or 'No' and indicating the procedure names and dates performed.
6. List current medications, including the name of each medication, dosage, and the date prescribed.
7. Summarize your treatment and return-to-work plan briefly.
8. Indicate if the patient has been non-compliant with the treatment plan and identify any non-medical factors that might affect their ability to work.
9. Outline activity restrictions and limitations, specifying what the patient should not do and what they cannot do. Include details about specific occupational duties impacted.
10. Confirm whether you have been supervising the patient’s care and note any treatment received since the last statement, along with the patient's perception of its helpfulness.
11. State your prognosis, selecting one of the options provided and including any necessary comments.
12. Determine if the patient is a suitable candidate for trial employment in their current or any other occupation and provide further details or comments as needed.
13. Attach any relevant medical records, consultation reports, test results, and hospital summaries that support the information provided.
14. Complete the signature section, including the physician’s name, address, degree and specialty, and date.
15. Finalize the form by saving changes, and prepare to download, print, or share the completed document according to your needs.

Begin completing your RBC 83738 form online today to ensure a smooth claims process.