TN 1 (05-00)
With or without the claimant's permission, when the CE discloses new diagnostic information
or test results that reveal potentially life-threatening situations, send a copy of
the CE report to the claimant's primary care provider.
Follow the steps below when sending the CE report to the claimant's primary care provider.
Claimant returns completed, signed authorization form
Release CE report to claimant's primary care provider.
Explain in a cover letter that the report is being sent at the request of the claimant.
Claimant returns signed authorization form without primary care provider name and/or
If the name and/or address can be obtained over the telephone, note this and the date
obtained on the bottom of the authorization form.
If the primary care provider name and/or address cannot be obtained over the telephone,
mail the authorization to the claimant for the primary care provider name and/or address
Release the CE report, if the claimant so desires. Explain in a cover letter that
the report is being sent at the request of the claimant.
If the claimant refuses to provide a name and address, handle as in DI 22510.065B.1.e.
Claimant telephones or returns unsigned authorization
Mail the authorization to the claimant for signature and return;
Place the signed authorization in the folder; and
Release the CE report as in DI 22510.065B.1.a.
Question is raised about whether individual named on authorization is a primary care
Determine whether the individual named is a primary care provider.
If yes, handle per DI 22510.065B.1.a. or DI 22510.065B.1.c.
If no, handle as a claimant access request in accordance with GN 03340.040.
NOTE: Do not delay adjudication when development is required under DI 22510.065B.1.b., DI 22510.065B.1.c., or DI 22510.065B.1.d. If the case is ready to be released, retain a copy of the CE report. Once action
is completed on the authorization, forward it for association with the folder.
Claimant does not return authorization
Take no further action unless the CE report discloses new information that reveals
a potentially life-threatening condition (see DI 22510.020B.4.).
If the claimant returns the authorization form:
Place it in the folder.
Take no further action.
See NL 00705.745C for obtaining the claimant's authorization for release of the CE report.
See DI 22510.020B.4.a. for notifying the claimant when referring the CE report to the claimant's primary