Items 30-33 “Document additional information in a Case Note in the Disability Case Processing System (DCPS), or on the Case Development Worksheet (CDW)

Enter the following:

Item 30 - disability examiner signature

Item 31 - date disability examiner signed the determination

If the case contains no medical evidence, leave items 32-33 blank.

In all other cases, enter the following:

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  Item 32 –the name and the date of the medical assessment form containing the medical evaluation (For example, “RFC dated MM-DD-YYYY”).

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  Item 32A - name of the MC or PC who signed the medical assessment form containing the medical evaluation.

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  Item 32B - the medical specialty code of the MC or PC who completed the medical assessment form containing the medical evaluation. (For medical specialty codes, see DI 24501.004.)

  NOTE: For electronic processing, the medical specialty code propagates from the disability determination services case processing system.

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  Item 33 - date the MC or PC signed the medical assessment form containing the medical evaluation.