Medical Knowledge and GTM Associate•February 11, 2026•9 min read
Fact checked by Dr. Ben Condon
Section Name: BlockContentHighlights
Attending Physician Statement Template
This Attending Physician’s Statement template is designed to document a patient’s critical illness diagnosis, treatment history, and prognosis for insurance claim evaluation. It includes sections on medical findings, test results, and details on the patient’s limitations due to illness. Used with Heidi, the AI medical scribe for all clinicians, this template helps physicians to easily:
Capture detailed clinical information, including diagnosis, date of onset, objective findings, and current treatments such as surgeries, medications, or therapies.
Identify the patient’s functional limitations in daily living activities such as cooking, cleaning, and mobility, along with the timeline of onset and whether these impairments are temporary or permanent.
Outline prognosis, expected recovery timeline, and any additional observations that may impact the patient’s claim like positive responses to treatment, absence of neurological deficits, and usage of tobacco products, among others.
What is an Attending Physician Statement Template?
An (APS) Template is a standardized document used by primary physicians to summarize important medical information about a patient. It commonly includes fields to document the patient’s basic information, medical history, current condition, medications, functional capacity, and treatment dates.
In this article, we’ll explain why APS templates are important, provide guidance on how to complete your own APS templates with examples, raise awareness on the common mistakes you need to avoid, and most importantly, share ready-to-use and AI-enabled templates for use in your daily practice.
Why are Attending Physician Statement Templates Important?
APS templates are essential because they provide a standardized and structured way for doctors to communicate a patient’s medical history, current condition, and prognosis. They’re often required by insurance companies and government agencies to verify claims, assess disability eligibility, or support benefit applications.
According to industry insights, approximately 60% of life and disability insurance applications involve an APS request. For example, consider a 50-year-old patient applying for long-term disability benefits after being diagnosed with multiple sclerosis.
The insurance provider requires detailed evidence of how the condition affects the patient’s ability to work, so the attending physician completes an APS template to document the patient’s diagnosis, progressive symptoms, treatment plan, and specific functional limitations. This clear and structured information allows the insurer to make an informed decision and helps avoid delays or denials due to missing or unclear medical documentation.
Another example is when a patient files a critical illness claim after undergoing heart surgery. A complete attending physician statement from the attending cardiologist can confirm the diagnosis, date of procedure, and recovery timeline, ensuring faster claim processing.
How to Complete an Attending Physician Statement Template with Examples
The information included in APS templates is often used in disability, insurance, and legal claims; this means utmost accuracy and clarity are critical since mistakes or vague responses can delay approvals or worse, lead to claim denials.
Let’s talk about the most important sections of APS templates, and go through some examples to guide you in practice:
Patient and Physician Information
The opening section should cover basic details such as the patient’s name and date of birth, as well as the physician’s name, specialty, and contact information. Double-check the identifying information for both the patient and physician to avoid potential processing delays due to information mismatch.
Example: Patient Name: Larry Johnson Date of Birth: 03/14/1980 Physician: Dr. Jennifer Holden, Internal Medicine Phone Number: 415-555-9876
Diagnosis and Medical History
Next, ensure that the patient’s current diagnosis is clearly stated with a matching ICD-10 code, along with any relevant medical history that contributes to their current condition.
Relevant History: Chronic lower back pain since 2021, exacerbated by work-related activity.
Treatment Plan and Prognosis
Outline the treatments that are being administered, such as medications, therapy, or surgery, and provide details on the patient’s current progress. Don’t forget to include information on upcoming appointments, recovery timelines, or whether the patient’s condition is expected to improve, stabilize, or worsen.
Example: Current Treatment: Physical therapy 2x a week; Naproxen 500mg daily
Prognosis: Moderate improvement expected with continued therapy over 3-6 months
Functional Capacity and Limitations
For disability and insurance purposes, it’s important to specify the patient’s limitations with regards to daily activities or their ability to return to work. Make sure to include information on both physical and cognitive limitations where applicable.
Example: Patient is currently unable to lift more than 10 lbs, stand for more than 15 minutes, or sit at a desk for more than 30 minutes without breaks. Not cleared for return work.
Additional Comments or Recommendations
Lastly, include details regarding referrals, test results, specialist notes, follow-up actions, or any other details the attending physician feels would be relevant to the claim.
Example: Recommended MRI of lumbar spine to evaluate possible nerve compression. Referral sent to neurology.
Dr. George Verghese, a GP partner at London’s Waterloo Health Centre, was struggling to balance a growing patient list with increasing administrative duties. "The number of patient contacts in a day is significantly higher than they have ever been. The nature of work is also much more complicated," he shared.
Despite efforts to distribute administrative tasks and hire additional team members, the workload was overwhelming. After adopting Heidi, Dr. Verghese and his team quickly noticed the benefits, with Heidi automating documentation and transcribing non-clinical meetings in real time, saving up to two hours per day on administrative tasks.
"Heidi now really allows me to just maximally focus on what I have been trained to do, rather than all of the other admin bits," said Dr. Verghese. The team at Waterloo Health Centre has found that Heidi’s ability to streamline documentation not only alleviated clinician burnout but also improved overall productivity, enabling them to focus more on patient care.
Common Mistakes to Avoid in Attending Physician Statement (APS) Templates
As previously established, even small errors in APS templates can lead to claim denials, delayed benefits, or legal complications. With a careful review process and an understanding of what third parties like insurers or attorneys look for, you can avoid costly issues when completing your APS forms:
Leaving Sections Incomplete or Blank
It’s not unusual for APS forms to be rejected or sent back because some of the fields are left empty. To avoid this issue, it’s good practice to use “N/A” or “unknown” in certain fields that don’t need to be specified instead of leaving them blank. This shows third-party reviewers that those fields were considered, instead of giving the impression they were simply missed.
Providing Vague and Non-Specific Medical Information
Avoid including general statements like “patient has back pain” without diagnostic support, functional impact, or accompanying ICD-10 codes. Third parties will always look for measurable and concrete information, so make sure to include important dates, patient limitations, as well as test results when filling out your APS template.
Conflicting or Inconsistent Information
Stating the patient “cannot work” in one section, but marking “light duty approved” in another can potentially trigger a red flag from the reviewer’s end. You can prevent this from happening by doing a thorough review for consistency prior to submission, especially if multiple staff members or physicians contributed to the APS template’s completion.
Omitting Functional or Work-Related Limitations
Remember that disability and insurance claims often hinge on how a specific condition affects a patient’s ability to work or function on a daily basis. Omitting this section might result in either automatic claim denials or requests for additional documentation, leading to delays.
Failing to Explain the Prognosis or Next Steps
Prognosis fields are often underused or skipped, even if they’re critical in cases of long-term disability or legal evaluations. Even if the patient’s outlook is uncertain, it’s still better to state this openly in the prognosis section instead of leaving it blank.
Section Name: BlockContentHighlights
Attending Physician Statement Template Example
You can download a copy of this document, or auto-fill it seamlessly with Heidi, your AI care partner.
Attending Physician Templates can be filled out manually, either with pen-and-paper, or via electronic templates. Manual processes, however, lack safeguards against errors, missed details, and inconsistencies in data. These issues can be especially problematic in the context of insurance claims and legal documentation.
Thankfully, our AI-powered solution gives you a more efficient way to complete your APS templates without sacrificing accuracy and quality.
Section Name: BlockContentHighlights
Easily Complete Attending Physician Statement Templates with Heidi
Heidi is our state-of-the-art AI medical scribe designed to help physicians complete their APS templates in real-time. With your patient’s permission, simply hit record and let Heidi work as you go. Here’s how Heidi helps you complete your case notes:
Transcribe – Open Heidi on your computer or mobile device and press Start so Heidi can capture your consultation in the background. For information that you don’t want to verbalize, you can type them under context notes to be considered later.
Customize – After the session, simply select your preferred APS template and watch as Heidi perfectly transcribes the details of your conversation and context notes in the appropriate fields and format!
Transform – After generating your completed APS template, you can ask Heidi to generate additional documentation, including past medical history forms and progress notes as needed.
Heidi complies with jurisdiction-specific regulations, ensuring data localization for customers in Australia, Canada, the United States, the United Kingdom, and beyond. Read more about our patient safety and data security compliance here.
This Physician Statement Form template is designed to help physicians document patient cases for medical or surgical expense reimbursements. It includes fields to cover general patient data, their hospitalization and consultation details, along with a declaration and an authorization section.
Generic Attending Physician Statement Form Template
This Generic Attending Physician Statement Form template is a comprehensive document designed to outline a patient’s critical illness or dismemberment condition in support of insurance claims. It includes fields to document detailed medical information including diagnosis, treatment history, and the patient’s ability to perform daily activities.
FAQs About Attending Physician Statement Templates
Regional guidelines may vary depending on your local healthcare regulations and insurer requirements, but most jurisdictions require that APS templates are completed by licensed physicians, include specific ICD-10 codes, and adhere to privacy laws such as HIPAA (in the United States), the Australian Privacy Act, New Zealand Privacy Act, or the General Data Protection Regulation (in Europe) depending on your practice’s location.
