Basic (04-09)

GN 01750.310 Czech Republic Agency Requests for Medical Examinations

A. Background

If CSSZ requests a medical examination for a U.S. resident, SSA will schedule the examination and send the results to CSSZ.

B. Process

Use the following process for obtaining medical examination for CSSZ. (For general information on processing requests for medical examinations, see GN 01704.810.)

1. CSSZ requests for medical examinations

CSSZ requests for medical examinations are in item D; section IV on form CZ/USA 3.

2. SSA schedules examinations or forwards pertinent medical evidence

SSA schedules an examination or forwards “pertinent medical evidence” from SSA files. SSA’s files include claims folders in DIO or in the caves in Kansas City.

Pertinent medical evidenceis evidence obtained by SSA in connection with a continuing disability review or a disability claim filed or adjudicated within a year of the date for which CSSZ has specifically requested medical evidence.

SSA will arrange for the form CZ/USA 213 to be completed or the consultative medical examination be performed if requested to do so by CSSZ. CSSZ will bear the costs of this service. A respective SSA field office employee will verify and stamp the form CZ/USA 213 before forwarding it to CSSZ. SSA will forward the liaison/communication form stating SSA arranged for the consultative medical examination.

3. SSA requests reimbursement for cost of medical examinations

SSA requests reimbursement for the cost of medical examinations obtained for the CSSZ using form SSA-1278-CZ (Request for Payment of Reimbursable Expenses under the U.S.-Czech Republic Agreement on Social Security - USA/CZ-9).

NOTE: Print this form from the SSA Totalization Forms section of the Totalization Resource Kit .

C. Reference

GN 01704.810, Requests for Medical Examinations/Evidence.

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GN 01750.310 - Czech Republic Agency Requests for Medical Examinations - 04/27/2017
Batch run: 04/27/2017