Manulife-Disability-Claim-Member-Statement 2026

1. Click ‘Get Form’ to open the Manulife-Disability-Claim-Member-Statement in the editor.
2. Begin by completing the 'Patient Authorization' section on page 2. Ensure that the patient’s name, division number, and plan member certificate number are clearly filled out. The patient must sign and date this section.
3. Move to the 'Attending Physician's Statement' section. Fill in the primary diagnosis and any additional diagnoses or complications. If applicable, provide the GAF score for psychiatric disorders or functional classification for cardiac disorders.
4. In the 'Clinical Information' section, document key dates such as when symptoms first appeared and when treatment began. Specify if the condition is due to an injury or illness and detail visit frequencies.
5. Complete sections regarding treatment details, including names of other practitioners, current medications, and any hospitalizations. Be sure to note responses to treatments.
6. Finally, review all sections for completeness before submitting. You can either send it directly to Manulife or provide it to your patient.

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