For a Lincoln Financial group short-term disability claim, the attending physician answers a single page of numbered questions. They cover symptom onset, the date the patient stopped work, prior similar conditions, work relatedness, diagnosis, pregnancy due date, findings and treatment, progress, confinement, dates of total disability, and whether the patient is totally disabled from their present occupation or from all occupations.
The attending physician answers questions 1 to 27, including the patient's name, birth date and policy number, and signs personally, since stamps are not accepted. There is no patient or employer section.
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Short Term Disability Attending Physician's Statement
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No. The signature line on GLC-01817ATL reads Signature (By Physician) No Stamps Please, so the attending physician must sign it personally. The physician also prints their name, degree, telephone number and complete address.
The physician gives the date symptoms appeared or the accident happened, the date the patient ceased work because of disability, the first and last visit dates, any hospital confinement dates, the dates of total disability and, for pregnancy, the estimated delivery date.