Loading
Get Cigna 618136 2011-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the CIGNA 618136 online
The CIGNA 618136 form is essential for evaluating disability claims. This guide will assist you in accurately completing the form for effective submission.
Follow the steps to successfully complete the CIGNA 618136 form.
- Press the ‘Get Form’ button to access the form and have it open for your completion.
- Begin by entering the claimant's name and date of birth in the designated fields. This is vital for identification purposes.
- Clearly specify the primary diagnosis and include the corresponding ICD-9 code to classify the condition.
- Indicate whether the condition is work-related by choosing 'Yes' or 'No'. Provide the date of the injury or illness if applicable.
- Detail any additional factors affecting the patient's return to work, such as ongoing treatments or personal circumstances.
- Record the date when you first treated the patient for this impairment episode. Indicate whether this treatment is part of a prior impairment episode.
- Fill in the date of the last visit and the date for the patient's next office visit to keep track of medical progress.
- List treatments included in the current treatment plan like physical therapy or surgery, and ensure to provide supporting documentation.
- Document all current medications related to the impairment, including dosage and frequency to give a comprehensive view of the patient's treatment.
- Outline specific restrictions placed on the patient's work and home activities to ensure proper assessment and necessary accommodations.
- Address whether the patient could return to work if accommodations were made and provide an estimated timeline for their return with and without restrictions.
- Finally, sign the form at the bottom, providing your name, degree and specialty, contact details, and federal tax ID number.
- Review the completed form for accuracy, then save changes, download, print, or share the form as required for submission.
Complete your CIGNA 618136 form online today for timely processing of your disability claim.
Related links form
Yes, you can upload documents to Cigna through their secure online portal. This feature allows you to submit medical bills, claims, and other important documents conveniently. Just remember to reference your CIGNA 618136 information for proper identification in the document submission process.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.