DDS will follow instructions in POMS DI 20502.030 for handling reconstruction requests. DDS will advise the HO of any delays in expected
completion of the reconstruction. Once medical reconstruction is complete, DDS will
forward all material directly to the HO. The RO does not need to be notified.
EXHIBIT 1 — San Francisco Region APPEALS PROCESSING
RECONSTRUCTION FOLDER FLAG
TO: ______________________ DATE: _________________
(Hearing Office)
______________________
______________________
CLAIMANT/APPELLANT NAME ______________ SSN: _________________
I. RECONSTRUCTION OF NON-MEDICAL EVIDENCE
_____ Enclosed is the __(RSI, DIB, SSI)______ reconstructed non-medical evidence.
II. RECONSTRUCTION OF MEDICAL EVIDENCE
_____ The request for medical reconstruction was forwarded to the ____________________________
DDS on ________________.
(DDS branch name, city & state) (date)
Questions concerning the reconstruction of this medical evidence should be directed
to ______________________ at telephone number __________________.
(name of DDS contact) (DDS telephone number)
FROM: _________________________________
(FO contact person and title)
_________________________________
(FO name and office code)
_________________________________
(telephone number)
(REPRODUCE LOCALLY)
EXHIBIT 2 — San Francisco Region APPEALS PROCESSING
REQUEST FOR MEDICAL RECONSTRUCTION FLAG
TO: ________________________ DATE: ____________________
(DDS)
________________________
(ADDRESS)
________________________
A REQUEST FOR HEARING WAS FILED ON _______________________ BY
(date)
______________________________, ______________________________.
(name) (SSN)
WE HAVE BEEN UNABLE TO LOCATE THE FOLDER AND MUST RECONSTRUCT THE EVIDENCE.
PLEASE IMMEDIATELY BEGIN RECONSTRUCTION OF THE MEDICALS FOR:
___________________________________________________________
(TYPE OF CLAIM: TITLE II, XVI, CONCURRENT, COMMENTS)
ENCLOSED ARE:
_____ MEDICAL RELEASE FORMS
_____ SSA-3368
_____ OTHER FORMS APPROPRIATE TO THIS TYPE OF CLAIM
_____________________________________________
_____________________________________________
THIS RECONSTRUCTION MUST BE COMPLETED WITHIN 30 DAYS OF THE DATE THAT THIS REQUEST
IS RECEIVED. WHEN COMPLETED, IT MUST BE FORWARDED DIRECTLY TO THE HEARING OFFICE AT:
___________________________________________________________
(address)
___________________________________________________________
(HO Telephone number)
QUESTIONS CONCERNING THE EVIDENCE TO BE RECONSTRUCTED SHOULD BE DIRECTED TO THE HEARING
OFFICE.
FROM: __________________________________
(signature and title of FO person)
________________________________
_________________________________
(FO telephone number)
(REPRODUCE LOCALLY)