Attending Physician Statement - APS Notes

How long do you believe the symptoms had been present when you were first consulted?: [insert symptom duration] (Provide an estimation of symptom onset duration prior to first consultation; include only if stated) 1. Diagnosis (Full and exact details. If cancer, please specify the stage): [insert diagnosis and staging details] (Write a paragraph in full sentences stating the precise diagnosis, and if applicable, the cancer stage; include only if mentioned) 2. Underlying cause of the patient’s condition: [insert underlying cause] (Explain in a full sentence or short paragraph the aetiology or pathophysiological explanation for the patient’s condition; include only if mentioned) 3. Objective findings supporting the diagnosis and prognosis: [insert objective findings] (Include results of tests such as histopathology, imaging, ECG, MRI, etc., along with test dates; list clearly in sentence format or line-by-line if appropriate; only include if explicitly mentioned) Date of surgery, if applicable (month/day/year): [insert surgery date] (Include only if a surgical procedure occurred and the date is available) 4. Is the patient capable of performing activities of daily living?: [insert ADL capacity] (State clearly if the patient can or cannot perform ADLs. If not, list specific activities affected and since when; include only if documented) Activities of Daily Living he/she cannot perform: [insert ADL limitations] (Include detailed list or short paragraph of specific ADLs the patient cannot perform; only if applicable) Since when? (month/day/year): [insert date since ADL limitation began] (Include only if limitation duration is explicitly stated) 5. What kind of treatments has the insured received in relation to the condition?: [insert treatments received] (Describe in a paragraph all treatments the patient has undergone, including medications, procedures, therapy, or other interventions; only include if specified) 6. Were there other treatments/procedures recommended to the insured?: [insert recommended treatments] (Write in a sentence or paragraph format the treatments suggested but not yet completed; include only if applicable) Since when (month/day/year): [insert recommendation date] (Include only if date of recommendation is provided) Expected Recovery (month/day/year): [insert expected recovery date] (Include only if stated in the original documentation) 7. Did the patient's condition result in any major, permanent neurological deficit that will require physical rehabilitation?: [insert neurological impact and rehab need] (Answer Yes or No followed by a sentence or short paragraph explaining the nature of any neurological deficits and rehabilitation plans; include only if explicitly stated) 8. Has the patient been hospitalized or attended to for any other medical condition?: [insert hospitalisations or other conditions] (Include details of all relevant hospitalisations or coexisting medical conditions, including date ranges and diagnoses; include only if stated) Past Health History: Name and Addresses of Attending Physician: [insert previous attending physician information] (Include full names and addresses of physicians who treated the patient for other conditions; include only if mentioned) Date of Consultation: [insert date of consultation] (Include only if stated) Diagnosis: [insert diagnosis for each consultation] (Include as a short line for each relevant encounter; only if mentioned) Period of Consultation: [insert period or date range] (State the overall timeframe for previous consultations; only if provided) Are you the patient’s regular attending physician?: [insert answer with explanation if Yes] (Answer Yes or No. If Yes, include short explanation; only if this detail is documented) 9. Has the patient been referred to other physicians?: [insert referrals] (List physicians the patient has been referred to, including names and specialties; only include if explicitly mentioned) 10. Does the patient smoke cigarettes/cigarillos/cigars or consume any other tobacco product?: [insert tobacco use] (State Yes or No and provide the quantity per day for each type of tobacco product if the answer is Yes; include only if recorded) (Only include if the answer is Yes) Quantity per day – cigarettes: [insert quantity] Quantity per day – E-cigarettes: [insert quantity] Quantity per day – cigars: [insert quantity] Quantity per day – others: [insert quantity and type] When was the last time the patient smoked or used tobacco?: [insert date] (Enter month and year; include only if stated) 11. Additional information relevant to this claim: [insert additional physician comments] (Provide any other relevant medical or contextual information that may support claim processing; use paragraph format; only include if applicable) Signature Signature of Attending Physician: [insert physician signature] (Include only if signature is provided) Printed Name: [insert printed name of physician] (Include in full format with surname, first name, and middle initial if applicable) Field of Specialization: [insert physician specialty] (Include medical specialty or area of certification; only if mentioned) PTR No.: [insert PTR number] (Include professional tax receipt number; only if provided) License No.: [insert license number] (Include national or local license registration number; only if stated) Contact Number/s: [insert physician contact information] (List phone numbers; include only if documented) Email Address: [insert email address of physician] (Include only if email is documented) Date of Signing (month/day/year): [insert date of signing] (Write full date format; include only if provided) Place of Signing: [insert location of signing] (Include geographic location such as city or province where form was signed; only if mentioned) Clinic Hours: [insert regular clinic hours of physician] (Include only if stated) (Never come up with your own patient information, diagnoses, test results, clinical timelines, treatment plans, opinions, tobacco usage, or professional identifiers — use only the transcript, contextual notes or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Maintain the structure and layout exactly as shown in the example form.)