Attending Physician Statement Template 2009-2025 Form

What is the Physician Statement

The attending physician statement is a formal document that provides essential information about a patient's medical condition, treatment, and prognosis. This statement is typically required by insurance companies when processing claims, particularly for disability benefits or life insurance. It serves as a verification of the patient's health status and the physician's professional opinion regarding their ability to work or perform daily activities.

Key Elements of the Physician Statement

An effective attending physician statement template includes several critical components:

• Patient Information: Full name, date of birth, and contact details.
• Medical History: Relevant past medical conditions and treatments.
• Current Diagnosis: Detailed description of the patient's current health issues.
• Treatment Plan: Outline of ongoing treatments and medications.
• Prognosis: The physician's assessment of the patient's future health and ability to work.
• Physician's Information: Name, contact information, and signature of the attending physician.

Steps to Complete the Physician Statement

Completing the attending physician statement involves several straightforward steps:

• Gather Patient Information: Collect all necessary details about the patient, including identification and medical history.
• Document Current Health Status: Provide an accurate and comprehensive account of the patient's current diagnosis and symptoms.
• Outline Treatment and Prognosis: Clearly state the treatment plan and the expected outcome for the patient.
• Review for Accuracy: Ensure all information is correct and up-to-date before finalizing the document.
• Sign and Date: The attending physician must sign and date the statement to validate it.

Legal Use of the Physician Statement

The attending physician statement holds legal significance, particularly in insurance contexts. It is essential that the document meets certain legal requirements to be considered valid. Compliance with regulations such as the ESIGN Act ensures that electronic signatures are legally binding. Additionally, the statement should be completed accurately to avoid any potential disputes regarding the patient's health status or the validity of claims made to insurance providers.

How to Obtain the Physician Statement

To obtain an attending physician statement, patients typically need to request it directly from their healthcare provider. This process may involve:

• Contacting the Physician's Office: Reach out to the office to request the statement, providing necessary patient details.
• Filling Out Required Forms: Some offices may require specific forms to be completed before issuing the statement.
• Allowing Time for Processing: Understand that preparing the statement may take time, depending on the physician's schedule and the complexity of the case.

Examples of Using the Physician Statement

The attending physician statement is commonly used in various scenarios, such as:

• Disability Claims: Insurance companies often require this document to assess eligibility for disability benefits.
• Life Insurance Applications: Insurers may request the statement to evaluate the risk associated with providing coverage.
• Workers' Compensation Claims: Employers may need this document to process claims related to workplace injuries.