TN 3 (02-01)
DI 22505.021 Developing Evidence from Hospitals and Clinics
A. Procedure - the Request
Use the instructions below to develop evidence from hospitals and clinics.
1. Claimant Identification Information
Provide the following information:
Date of birth
SSN, if required by vendor.
2. Specific Information Needed
Specify the information needed:
Test results, e.g., laboratory, X-ray reports, pathology reports, etc., as appropriate.
Tracings, e.g., EKG, Spirometric, etc.
3. Specific Time Periods
Indicate specific dates for:
B. Procedure - Special Issues
Follow the instructions below in the identified special issues situations.
1. Specialized Clinics, Hospitals, or Wards
Include in the request:
Information in DI 22505.021A., as appropriate.
Specific medical evidence required per medical listing and evaluation guides.
2. Current Hospitalization
Because records of current hospitalizations are hard to get:
Request the needed evidence from the treating source, or
Contact the hospital's social service or patient resources department to request assistance.
3. Clarification of Records
Identify the specific issues requiring resolution.
First try to obtain clarification of those issues from the treating source.