Provide the following information:

1. a. 

   Name

2. b. 

   Address

3. c. 

   Date of birth

4. d. 

   Hospital number

5. e. 

   SSN, if required by vendor.

Specify the information needed:

1. a. 

   Summaries

2. b. 

   Test results, e.g., laboratory, X-ray reports, pathology reports, etc., as appropriate.

3. c. 

   Tracings, e.g., EKG, Spirometric, etc.

4. d. 

   Progress reports.

5. e. 

   Consultative reports.

Indicate specific dates for:

1. a. 

   In-patient records

2. b. 

   Out-patient records

   • •

     General clinics

   • •

     Specialty clinics

Include in the request:

1. a. 

   Information in DI 22505.021A., as appropriate.

2. b. 

   Specific medical evidence required per medical listing and evaluation guides.

Because records of current hospitalizations are hard to get:

1. a. 

   Request the needed evidence from the treating source, or

2. b. 

   Contact the hospital's social service or patient resources department to request assistance.

1. a. 

   Identify the specific issues requiring resolution.

2. b. 

   First try to obtain clarification of those issues from the treating source.