BASIC (10-15)

DI 28084.050 Signatures, Dates, Specialty Name and Specialty Codes (Items 25 to 28 and Items 30 to 33)

A. Introduction to completing Items 25 to 28 and Items 30 to 33

Follow these instructions to complete Items 25 through 28, and Items 30 through 33, when processing a continuing disability review (CDR) on the Forms SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal –Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II).

B. Item 25 - disability examiner signature

The disability examiner (DE) will sign the form here.

C. Item 26 - date

Enter the date of the current determination.

D. Item 27 -- physician or medical specialist, signature

For instructions on signature requirements and documentation of the medical consultant's (MC) or psychological consultant's (PC) determination, see DI 26510.090.

E. Item 28 – date

If the MC or PC only signed a medical evaluation document(s), the DE will enter the date the MC or PC signed that document(s). Otherwise, the MC or PC must enter the date the SSA-832 or SSA-833 is signed. For MC or PC signature requirements, see DI 26510.090.

F. Items 30 and 30A - physician or medical specialist name and specialty code

1. When to complete Items 30 and 30A

The DE (or the MC/PC, if signing the SSA-832 or SSA-833) must follow these procedures to complete Items 30 and 30A. For the MC or PC signature requirements, see DI 26510.090.

2. Procedure for completing Items 30 and 30A

a. Item 30

Type or print the MCs or PCs name.

b. Item 30A

Enter the MCs or PCs medical specialty code from the list below. If a MC has multiple specialties (internist and rheumatologist), enter the code most closely related to the case:

MC/PC SpecialtyCode

Anesthesiology

01

Ambulatory Medicine

02

Audiology

03

Cardiology

04

Cardiopulmonary

05

Dermatology

06

Eye, Ear, Nose, and Throat

07

Ear, Nose, and Throat

08

Ear and Throat

09

Emergency Room Medicine

10

Endocrinology

11

Family or General Practice

12

Gastroenterology

13

Geriatrics

14

Gynecology

15

Hematology

16

Industrial Medicine

17

Infectious Diseases

18

Internal Medicine

19

Neurology

20

Neuro-Ophthalmology

21

Neuro-Psychiatry

22

Neonatology

23

Nephrology

24

Obstetrics

25

Occupational Medicine

26

Oncology

27

Ophthalmology

28

Orthopedics

29

Osteopathy

30

Pathology

31

Pediatrics

32

Physiatry

33

Physical Medicine

34

Plastic Surgery

35

Preventative Medicine

36

Psychiatry

37

Psychology

38

Public Health

39

Pulmonary

40

Radiology

41

Rehabilitative Medicine

42

Rheumatology

43

Special Senses

44

Surgery

45

Urology

46

Other

47

Speech Language Pathology

48

Child and Adolescent Psychiatry

49

G. Items 31 through 33

Procedure for completing Items 31 through 33

An adjudicator or reviewer may use Items 31 through 33 in the CDR process not identified elsewhere. Enter in Item 32, the appropriate code from this list:

DestinationCode

DPB-NEPSC

01

DPB-MATPSC

02

DPB-SEPSC

03

DPB-GLPSC

04

DPB-WNPSC

05

DPB-MAMPSC

06

ODCO (other than DAP)

07

OEIO

08

DQB-Boston

10

DQB-Philadelphia

11

DQB-Chicago

12

DQB-Kansas City

13

DQB San Francisco

14

DQB-New York

15

DQB-Atlanta

16

DQB-Dallas

17

DQB-Denver

18

DQB-Seattle

19

Administrative Law Judge

20

Appeals Council

21

Other

22


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428084050
DI 28084.050 - Signatures, Dates, Specialty Name and Specialty Codes (Items 25 to 28 and Items 30 to 33) - 10/29/2015
Batch run: 10/29/2015
Rev:10/29/2015