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The hartford attending physician statement progress report pdf

The hartford attending physician statement 2025

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The document is an Attending Physician's Statement of Disability form from Hartford Life Insurance Company, designed to collect information about a patient's medical condition, treatment history, and limitations due to disability. It requires details from both the patient and the attending physician, including diagnoses, test results, treatment dates, and the extent of impairment in daily activities.

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Click ‘Get Form’ to open the hartford attending physician statement in the editor.
Begin by filling out the patient’s information, including their name, address, social security number, and date of birth. Ensure accuracy as this information is crucial for processing.
Next, provide details about the employer's name and division if applicable. The patient must authorize the release of information by signing and dating this section.
For the attending physician section, indicate whether the patient's condition is due to illness or injury. If pregnancy is involved, specify the expected date of delivery.
Complete the diagnosis section by entering primary and secondary diagnoses along with their corresponding ICD-9 codes. Include subjective symptoms and any relevant test results.
Document treatment dates and frequency of visits. If referrals were made to other physicians, include their details as well.
Finally, assess any impairments related to daily activities and provide your professional opinion on the patient's ability to function. Sign and date at the end of the form.

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2014	4.6 Satisfied (50 Votes)

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Who completes an attending physicians statement?

This statement, filled out by your attending physician, provides the disability insurance company with vital data to assess the validity of your disability claim. The APS can influence the decision-making process significantly, making it crucial to ensure it is accurately and thoroughly completed.

Who fills out APS?

It is written by your doctor, and the information contained in the APS varies and depends on what your insurer is looking for.

How to obtain an attending physician statement?

When you file your claim for short-term disability or long-term disability benefits, the insurance carrier will likely send you an Attending Physician Statement (APS) form for your treating medical provider to complete. While an APS looks simple, how an APS is completed can make or break your case.

Who might be asked to fill out a physicians statement driving?

Who needs the Physicians Statement of Examination for Driving? Individuals applying for a driving license who have health concerns. Physicians assessing a patients fitness to drive. Referring health care providers needing to submit a medical assessment.

What is the attending physician statement letter?

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.

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Who might be asked to fill out a physicians statement?

In order to be effective, an Attending Physician Statement must be completed by a doctor who knows you in person your insurer or agency will reach out to get information from a physician who has either treated you in the past or is currently providing treatment.

Who fills out attending physician statement?

Have the appropriate doctor complete the APS. You may have multiple doctors treating you for different medical issues, not all relating to your disability. It is important that the doctor treating your disabling condition is the one completing the APS.