TN 10 (11-11)
DI 22510.017 Consultative Examination (CE) Appointment Notice
20 CFR 404.1516 through 404.1519t , and 416.916 through 416.919t
A. Notifying the CE source of the appointment in writing
Notify the CE source of the appointment in writing and include the following:
Date and time of the CE appointment;
Required type of CE, required tests, and specific issues for the CE source to address;
Authorizing documents (e.g., an authorization for diagnostic services or claim for payment);
Form(s) to complete, such as a request for the CE source’s statement of what the claimant can still do despite his or her impairment(s);
A duplicate, fax, or other agency-approved electronic transmission of an originally signed and dated SSA-827 (Authorization to Release Information to the Social Security Administration), unless the source prefers to use its own authorization forms, see DI 11005.055; and
Background information on the claimant as described in this section.
B. Providing background information to the CE source
The quality of the background information sent to the CE source affects the quality of the CE report more than the quantity of the information. Provide any longitudinal information necessary to ensure a quality CE report, especially in cases involving mental impairments. Provide background information to the CE source based on the specific case facts, rather than on a minimum or maximum number of pages.
Provide duplicates or summaries of relevant evidence such as:
Medical evidence of record including any medical opinion(s)
The most recently completed disability report form in file (i.e., SSA-3368 (Disability Report-Adult), SSA-3820 (Disability Report-Child), SSA-3441 (Disability Report-Appeal), or SSA-454 (Continuing Disability Review Report)
Forms completed by the claimant or others, such as the SSA-3373-BK (Function Report-Adult)
Information extracted from documents used in communications, such as from a Disability Determination Services (DDS) medical or psychological consultant, if the information will be helpful to the CE source.
NOTE: Comply with State law governing the release of information. Do not offer any opinion, implied or stated, about the severity of the claimant’s impairment(s), or make any statement or comment that would be prejudicial to the claimant.
C. Notifying the claimant of the CE appointment in writing
Send a CE appointment notice to the claimant.
If the claimant has an appointed representative also send written notice to the appointed representative, see DI 22510.016C.
If the applicant is someone other than the claimant also send written notice to the applicant, see DI 22510.016D.
See options for notifying the claimant in writing of the CE appointment:
1. Using the CE appointment notice model letters
See model CE appointment notice and forms:
NL 00705.745A Model 1 CE appointment notice
NL 00705.745B Model 2 CE appointment confirmation form
NL 00705.745C Model 3 Authorization form for release of a copy of the CE report to the claimant’s doctor
2. Using the free-form CE appointment notice
If you do not use the model CE appointment notice NL 00705.745A, send a free-form CE appointment notice. Include the following:
Why we need the CE and why we may need additional tests;
Who the notice is from;
A statement that the Social Security Administration will pay for the appointment;
The date, time, type of the CE appointment, the name, address, and telephone number of the CE source (or your telephone number, if the CE source does not want his or her telephone number shared with the claimant);
Instructions for responding to the notice, including a request that the claimant respond immediately if he or she cannot attend the CE appointment or if the claimant’s medical source (MS) tells him or her not to attend the CE appointment;
A reminder the claimant must bring all medications in their original containers, along with any other medical aids (e.g., hearing aid(s) or eyeglasses) to the CE appointment;
Closeout language stating:
If you do not attend your appointment, we may make a decision based on the evidence we already have in your file. We