Cigna disability management solutions medical request form 2026

1. Click ‘Get Form’ to open the Cigna Disability Management Solutions Medical Request Form in our platform.
2. Begin by entering the Claimant Name and Date of Birth in the designated fields. This information is crucial for identifying the patient.
3. Provide the primary diagnosis responsible for the patient's impairment along with the corresponding ICD-9 code. This helps clarify the medical condition affecting their ability to work.
4. Indicate whether the condition is work-related by selecting 'Yes' or 'No'.
5. Detail any additional factors impacting return to work, and specify when you first treated your patient for this impairment episode.
6. List all current medications related to this impairment, including dosage and frequency, ensuring comprehensive documentation.
7. Complete sections regarding treatment plans, restrictions at work and home, and whether accommodations could facilitate a return to work.
8. Finally, fill in your details as the physician, including name, degree, specialty, address, telephone number, and signature before submitting.

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