What information is required in Block 16 if the patient is eligible for disability?

In Block 16 of the CMS-1500 form, if the patient is eligible for disability, it is essential to include the dates the patient is unable to work. This information is crucial as it helps the insurance carrier determine the period of disability and assess the claim for benefits appropriately. Including these dates allows the insurer to verify the nature and extent of the disability, which can impact the claim's approval for reimbursement of medical services related to the patient's condition.

While other options may seem relevant in certain contexts, they do not directly pertain to the information required in Block 16 regarding a patient's eligibility for disability. For example, a full medical history might be needed for comprehensive assessments, but it is not specifically requested in this block. Details about the referring physician are important for separate purposes, such as understanding care coordination, but they do not pertain directly to blocks that focus on the patient's work-related incapacity. Workplace information, while relevant in understanding the context of an injury or illness, is not the focus of the information needed in Block 16. Therefore, noting the specific dates of the patient's inability to work is the most pertinent information in this scenario.