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How to use or fill out Aetna Short Term Disability Attending Physician Statement

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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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Aetna short term disability attending physician statement 2026

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