During an open Guardian long-term disability claim, the treating provider completes GG-014468 so Guardian can see how far the patient is impaired. It asks for ICD-10 diagnoses and objective symptoms, the treatment plan and whether the patient follows it, expected recovery of previous function, surgery and hospital stays, work capacity, and an hour-by-hour picture of sitting, standing, walking, lifting, hand use and other abilities in an 8-hour workday.
The attending provider completes the whole form and gives their full name, qualification, degree and tax ID. The claimant's LTD case and claim numbers identify the file; there is no patient section.
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Group Claims Ongoing Attending Provider's Statement
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The provider lists the current recommendations and treatment plan with medications, therapies and rehabilitation, states whether the patient has been compliant, when the patient should return to previous functional levels, and whether the plan and recovery expectations have been discussed with and accepted by the patient.
Guardian asks for pertinent medical records, not limited to progress notes, diagnostic testing, discharge summaries, operative reports, consultations or mental status exams. The provider also records height and weight and the dates of the most recent and next office visits.