A physician’s statement is a formal, written document provided by a treating medical doctor that verifies a patient’s medical condition, treatment history, and physical or mental limitations. It serves as an official certification used for specific non-clinical purposes, such as receiving benefits or obtaining workplace accommodations. This document requires the physician to detail the medical facts of the patient’s health status, linking a diagnosed medical issue directly to an impairment in daily function or work capacity. The statement is typically submitted to a third-party entity, like an insurance provider or a government agency, to support a formal application.
Essential Information Required
A physician’s statement, often formally termed an Attending Physician’s Statement (APS) or Medical Source Statement, must contain specific, verifiable details to be considered valid. The document must begin with clear patient identification and the date of the examination upon which the statement is based. A formal diagnosis is required, usually documented using the standardized International Classification of Diseases (ICD) code system.
The statement must detail the patient’s treatment plan, including prescribed medications and the frequency of ongoing medical care. The most important section outlines the patient’s functional limitations, translating the medical condition into concrete restrictions. These limitations might specify an inability to lift a certain weight, restrictions on standing or walking for prolonged periods, or cognitive impairments affecting concentration. Finally, the physician must sign the document, including their medical license number and the date the statement was issued.
Primary Contexts Requiring a Statement
This detailed medical certification is mandatory in several administrative environments where a patient seeks formal relief or compensation due to a health condition. The most frequent application is for disability claims, encompassing both private short-term and long-term disability insurance policies.
The statement is necessary for several formal applications:
- Private disability claims, where insurers use the statement to determine if the medical condition meets the policy’s definition of disability.
- Government benefits, such as Social Security Disability Insurance (SSDI), where the Social Security Administration (SSA) requires a Medical Source Statement defining the patient’s residual functional capacity (RFC).
- Family and Medical Leave Act (FMLA) applications, certifying the medical necessity and expected duration of time off work for the patient or a family member.
- Requests for reasonable accommodations in the workplace or an educational setting under policies like the Americans with Disabilities Act (ADA).
How Statements Differ From Basic Notes
A physician’s statement is fundamentally different from a simple doctor’s note, which is typically an informal slip of paper confirming a recent appointment or a single day of illness. The formal statement is a comprehensive, targeted report, often completed on a multi-page form provided by the requesting entity. While a basic note confirms a clinical encounter, the statement focuses specifically on the functional impact of the condition on the patient’s ability to work or perform daily tasks.
The statement is also distinct from a full release of medical records, which contains all Protected Health Information (PHI). The physician’s statement, by contrast, is a summary tailored to answer the specific questions posed by the third party, limiting the disclosure of sensitive but unrelated medical information. This targeted approach requires the patient to provide a specific HIPAA authorization.
Navigating the Request Process
Obtaining a physician’s statement must be initiated by the patient, who generally begins by contacting their physician’s medical records or administrative department. The patient must provide the doctor with the specific forms required by the insurance company or government agency, ensuring the physician knows exactly what information is needed.
Because the statement is a detailed administrative service requiring significant time outside of direct patient care, medical practices typically charge an administrative fee for its completion. This fee is legally the patient’s responsibility and is not billable to health insurance. Patients must also sign a specific authorization form, often a HIPAA release, which permits the release of the detailed medical information to the third party. Given the complexity of the forms, patients should expect a turnaround time that can range from a few weeks to over a month, which should be factored into any application deadlines.