Get Ssa-3819 2010-2025

The SSA-3819 form, known as the Medical and School Worksheet for a Child, is crucial in preparing for interviews regarding a child’s medical and educational needs. Filling it out accurately helps ensure a smoother interview process and the timely gathering of necessary information.

Follow the steps to complete the SSA-3819 online effectively.

1. Press the ‘Get Form’ button to access the SSA-3819 document and open it in the editing interface.
2. In section A, provide the child’s height and weight as requested.
3. Section B requires the name, address, phone number, and relationship of another adult involved in the child's care who can assist in providing additional information.
4. In section C, list any illnesses, injuries, or conditions that the child has experienced.
5. Specify in section D when the child’s condition(s) began.
6. In section E, describe how these conditions affect the child’s daily activities.
7. Section F asks for the child’s current grade if they are attending school.
8. In section G, provide the names and addresses of schools or preschools the child is currently attending as well as any schools attended in the past 12 months, including details of special education services, if applicable.
9. Section H requires the names of the child’s current teachers and their respective schools.
10. In section I, list any school testing that the child has undergone, including the name and date of the tests, and the name of the school.
11. Section J asks for the name of any school therapists working with the child and the associated school name.
12. For section K, enter information about hospitals, clinics, doctors, or therapists who have treated the child in the past year, including addresses and patient ID numbers.
13. In section L, list other agencies or programs that have tested or examined the child or provided services, along with contact details and the type of service or test.
14. Section M requires you to list any medications the child takes along with the prescribing doctor's name.
15. Finally, in section N, outline all medical tests the child has had or will have, including the name of the test, date(s), where it was done, and who referred the child for testing.
16. Once all sections are complete, you can save your changes, download the form, print it, or share it as needed.

Start completing your SSA-3819 online today to ensure a smooth interview process.