DI BOS11005.025 Completing The SSA-3368-BK When The Claimant Has Had Medical Treatment In Puerto Rico
The DDSs often experience difficulty involving long delays in obtaining medical records
from claimants who have been treated in medical facilities in Puerto Rico. In order
to facilitate the retrieval of medical records, it is necessary to provide additional
patient identification information. This is in addition to complete identification
of the medical sources in Part II of the SSA-3368-BK, including patient or clinic
Whenever a claimant for DIB, DWB, or Title XVI adult claims alleges having had medical
treatment in Puerto Rico, the field office will obtain the following additional information:
Claimant's address in Puerto Rico when treated.
Claimant's place of birth.
Names of the claimant's parents. This should include the mother's maiden name.
State Insurance Fund (SIF) number, if Worker's Compensation is involved.
This information should be entered in the "Part VI - Remarks" section on page 6 of