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Attending Physician Statement - MGM Benefits Group

Attending Physician Statement - MGM Benefits Group 2025

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The document is an Attending Physician Statement form from Aetna Life Insurance Company, which outlines the process for patients and physicians to complete a medical information request. It emphasizes compliance with the Genetic Information Nondiscrimination Act (GINA) by prohibiting the provision of genetic information. The form includes sections for patient details, physician instructions, diagnosis, treatment history, abilities and limitations, and current status. It also contains legal notices regarding fraudulent claims specific to various states.

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Click ‘Get Form’ to open the Attending Physician Statement in the editor.
In Section 1, the Patient should fill in their name, gender, social security number, year of birth, weight, height, and home address. Ensure all fields are completed accurately.
The Patient must also indicate their employer details and job title while selecting the type of claim they are filing.
Sections 2 through 7 are to be completed by the Attending Physician. They will provide medical information based on a recent examination including diagnoses and treatment plans.
Ensure that all required fields are filled out completely before submitting. The physician should sign and date the form in Section 7.

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2013	4.8 Satisfied (66 Votes)

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Who completes an attending physician statement?

An attending physician statement (APS) is a report by a physician, hospital, or medical facility that has treated, or is currently treating, a person seeking insurance. In traditional underwriting, an APS is one of the most frequently ordered additional sources of medical background information.

What is the attending physicians statement?

An Attending Physician Statement (APS) is a form questionnaire from the insurance company that your treating doctor must complete. The purpose of the APS is for your doctor to docHub your inability to work.

What is included in an attending physician statement?

An APS will typically include: Diagnosis and medical history. Symptoms and severity. Functional limitations (what you can and cant do) Treatment plan and prognosis.