TN 29 (10-24)

NL 00705.753 Consultative Examination Report to Medical Source Cover Letter

AGENCY

LETTERHEAD

Date: Fill-in

Case ID: Fill-in

Addressee Name

Address Line 1

Address Line 2

City, State, Zip Code

RE: Claimant Full Name

AKA: AKA Name

DOB: DOB

 

We are the office that makes disability decisions for the Social Security Administration. [Claimant's full name] is applying for or is receiving disability benefits due to their medical condition(s).

 

If claimant has a medical source - permission granted:

[Claimant Full Name] has asked us to provide you a copy of the enclosed Social Security consultative examination/test report.

 

If claimant has an emergency, life or death situation where harm is believed to be imminent:

URGENT: Review is needed as soon as possible for a potentially life-threatening finding.

The Social Security consultative examination/test indicated a situation that requires immediate medical evaluation and/or treatment.

NOTE: Notify the claimant if a copy of the CE report was sent to the medical source without the claimant's permission. Include a copy of the letter to the claimant in Section E (Disability Related Development (Blue)) of the disability folder. See GN 03316.135C and DI 22510.070.

 

If You Have Any Questions

If you have any questions or wish to provide more information, please call us at the number(s) shown below Monday-Friday local office hours. When you call or leave a message, please provide the Case ID: case ID, your name, First Name Last Name's name, and a call back number.

Thank you for your help,

 

[Name]

[Phone Number]

[Fax Number]

 

Enclosures:

Copy of Consultative Examination Report


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900705753
NL 00705.753 - Consultative Examination Report to Medical Source Cover Letter - 10/11/2024
Batch run: 10/11/2024
Rev:10/11/2024