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How to use or fill out Aetna Short Term Disability Attending Physician Statement
- Click ‘Get Form’ to open the Aetna Short Term Disability Attending Physician Statement in our editor.
- Begin with the 'Patient Information' section. Fill in the patient's name, year of birth, claim number, employer name, and job title. Ensure all fields are completed accurately.
- Proceed to 'Dates of Disability'. Indicate the start and end dates of the disability, and specify if the condition is work-related. If applicable, provide the date of injury or illness.
- In the 'Restrictions and Limitations' section, detail any accommodations that can be made for modified duty assignments based on your assessment of the patient’s capabilities.
- Complete the 'Diagnosis/Symptoms' section by listing all relevant medical conditions along with their ICD-9 codes.
- Fill out the 'Surgery and Treatment' section if applicable, including hospitalization details and treatment summaries.
- Finally, sign and date the form at the bottom. Ensure that your contact information is also provided for any follow-up.
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| Versions | Form popularity | Fillable & printable |
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| 2012 | 4.9 Satisfied (44 Votes) |
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