Kansas Sample Letter regarding Certificate of Examining Physician

• Category: Letters - Legal - Conservatorships
• State: Multi-State
• Control #: US-0412LTR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Employee's Name] [Employee's Address] [City, State, ZIP Code] Subject: Certificate of Examining Physician — [Employer Name] Dear [Employee's Name], I hope this letter finds you in good health and high spirits. I am writing to provide you with the Certificate of Examining Physician required by the State of Kansas for your [medical leave/ disability/ Workers' Compensation claim]. As a licensed physician in the state of Kansas, I have thoroughly examined your medical condition and have provided an accurate assessment based on my professional expertise. This letter serves as an official statement outlining the details of your medical condition, which are essential for supporting your claim and ensuring that you receive the necessary benefits you are entitled to. Based on my evaluation, I can confirm that you are suffering from [specific diagnosis], which is a condition recognized by the International Classification of Diseases (ICD) code [specific code]. This condition severely affects your ability to perform your regular work activities, and therefore, it is necessary for you to take a [temporary/ extended] leave from your duties. The completion of this Certificate of Examining Physician is in compliance with the Kansas regulations outlined by the [Kansas Department of Labor/ Kansas Workers' Compensation Board/ Kansas Disability Services], and it will provide the necessary documentation for your employer and insurance provider to process your claim effectively. Please find attached the duly completed Certificate of Examining Physician for your review and submission. It includes the following information: 1. Employee's Information: — LegaNamam— - Social Security Number - Date of Birth — Job titlpositionio— - Department/Division 2. Employer's Information: — CompanNamam— - Address - Contact person — Phone numbe— - Email address 3. Medical Information: Diagnosissi— - ICD code - Date of onse— - Treatment plan — Expected duration oimpairmenten— - Additional relevant details Please note that it is crucial to submit this certificate within the specified time frame to avoid any unnecessary delays in processing your claim. If you require any additional information or have any questions, please do not hesitate to contact me at the provided contact details. I trust that this Certificate of Examining Physician will suffice to initiate the necessary procedures for your benefit claim. If any further medical documentation is required, please inform me, and I will be more than willing to assist you promptly. Wishing you a speedy recovery and a seamless claim process. Yours sincerely, [Your Name] [Medical License Number] [Medical Specialty] [Medical Clinic/Institution Name] [Address] [City, State, ZIP Code] [Phone Number] [Email Address] Keywords: Kansas, sample letter, Certificate of Examining Physician, medical leave, disability, Workers' Compensation claim, licensed physician, medical condition, diagnosis, ICD code, temporary leave, extended leave, Kansas Department of Labor, Kansas Workers' Compensation Board, Kansas Disability Services, completion, employer, insurance provider, duly completed, employee's information, medical information, treatment plan, impairment, diagnosis, medical documentation, medical clinic, medical institution.

[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Employee's Name] [Employee's Address] [City, State, ZIP Code] Subject: Certificate of Examining Physician — [Employer Name] Dear [Employee's Name], I hope this letter finds you in good health and high spirits. I am writing to provide you with the Certificate of Examining Physician required by the State of Kansas for your [medical leave/ disability/ Workers' Compensation claim]. As a licensed physician in the state of Kansas, I have thoroughly examined your medical condition and have provided an accurate assessment based on my professional expertise. This letter serves as an official statement outlining the details of your medical condition, which are essential for supporting your claim and ensuring that you receive the necessary benefits you are entitled to. Based on my evaluation, I can confirm that you are suffering from [specific diagnosis], which is a condition recognized by the International Classification of Diseases (ICD) code [specific code]. This condition severely affects your ability to perform your regular work activities, and therefore, it is necessary for you to take a [temporary/ extended] leave from your duties. The completion of this Certificate of Examining Physician is in compliance with the Kansas regulations outlined by the [Kansas Department of Labor/ Kansas Workers' Compensation Board/ Kansas Disability Services], and it will provide the necessary documentation for your employer and insurance provider to process your claim effectively. Please find attached the duly completed Certificate of Examining Physician for your review and submission. It includes the following information: 1. Employee's Information: — LegaNamam— - Social Security Number - Date of Birth — Job titlpositionio— - Department/Division 2. Employer's Information: — CompanNamam— - Address - Contact person — Phone numbe— - Email address 3. Medical Information: Diagnosissi— - ICD code - Date of onse— - Treatment plan — Expected duration oimpairmenten— - Additional relevant details Please note that it is crucial to submit this certificate within the specified time frame to avoid any unnecessary delays in processing your claim. If you require any additional information or have any questions, please do not hesitate to contact me at the provided contact details. I trust that this Certificate of Examining Physician will suffice to initiate the necessary procedures for your benefit claim. If any further medical documentation is required, please inform me, and I will be more than willing to assist you promptly. Wishing you a speedy recovery and a seamless claim process. Yours sincerely, [Your Name] [Medical License Number] [Medical Specialty] [Medical Clinic/Institution Name] [Address] [City, State, ZIP Code] [Phone Number] [Email Address] Keywords: Kansas, sample letter, Certificate of Examining Physician, medical leave, disability, Workers' Compensation claim, licensed physician, medical condition, diagnosis, ICD code, temporary leave, extended leave, Kansas Department of Labor, Kansas Workers' Compensation Board, Kansas Disability Services, completion, employer, insurance provider, duly completed, employee's information, medical information, treatment plan, impairment, diagnosis, medical documentation, medical clinic, medical institution.