If the Chilean agencies need additional medical evidence to process a claim for a U.S. resident, they will request SSA to schedule a medical examination. SSA will schedule the examination and send the results to the Chilean agencies.

Chilean agency requests for medical examinations will be made on Form CHI/USA 3. The Chileans will use a separate form or letter to specify the type of examination or medical tests that they need.

Use the following procedure to respond to Chilean agency requests for medical examinations:

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  Schedule an examination or forward “pertinent medical evidence” from SSA files.

  Pertinent medical evidence is evidence that was obtained by SSA within one year of the filing date shown on the foreign agency request or within one year of the date for which the Chilean agency has specifically requested medical evidence.

  SSA files include claims folders in DIO, a PSC, a FO, OCO's Megasite or the caves in Kansas City. However, it does not include folders in ODAR.

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  Request reimbursement for the cost of medical examinations obtained for Chile using Form SSA-1278-CHI (USA/CHI 9). Prepare three copies of this form.

  NOTE: This is an electronic form and can be located by selecting “TOTALIZATION FORMS” from the Table of Contents in the Totalization Resource Kit. The form is completed on the screen.

Requests for medical examinations/evidence, GN 01704.810.