Attending physician statement 2026

1. Click ‘Get Form’ to open the attending physician statement in the editor.
2. In Section 1, the patient should fill in their name, gender, social security number, birth date, and home address. Ensure all fields are completed accurately.
3. The attending physician will complete Sections 2 through 7 based on a recent examination. Make sure to attach any additional documentation if necessary.
4. In Section 3, provide details about the patient's impairing diagnosis and treatment dates. Include primary and secondary diagnoses along with their corresponding ICD codes.
5. Complete Section 5 by indicating the patient's abilities and limitations regarding work activities. Specify any medical restrictions that apply.
6. Finally, in Section 7, the attending physician must print their name, specialty, contact information, and sign the form before submission.

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