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PLEASE COMPLETE THE INFORMATION ON THE REVERSE OF THIS FORM Form SSA-787 05-2010 ef 05-2010 Destroy Prior Editions 1. SOCIAL SECURITY ADMINISTRATION Form Approved OMB No* 0960-0024 TOE 250 PHYSICIAN S/MEDICAL OFFICER S STATEMENT OF PATIENT S CAPABILITY TO MANAGE BENEFITS Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U. In replying use this address S*C. 3507 as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not need to SOCIAL SECURITY ADMINISTRATION answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions gather the facts and SECURITY OFFICE* You can find your local Social Security office through SSA s website at www. socialsecurity. gov* Offices are also listed under U*S* Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 TTY 1-800-325-0778. Send only comments re....

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How to fill out the SSA-787 online

Filling out the SSA-787 form is a crucial method for assessing a person's capability to manage their Social Security benefits. This guide provides a clear and systematic approach to completing the form online, ensuring you have the necessary information at hand.

Follow the steps to complete the SSA-787 online accurately.

  1. Press the ‘Get Form’ button to download the SSA-787 form and open it in the available editor.
  2. Begin by filling in the identifying information section, including the patient’s name, Social Security number, date of birth, and address. Ensure all data is accurate and complete.
  3. Provide details regarding the medical source, including their name, address, title, and telephone number.
  4. Respond to questions regarding your relationship with the patient, starting with the date you first saw the patient and the date of the last visit.
  5. Indicate how many times you have seen the patient to assist in assessing their ability to manage funds.
  6. Assess the patient’s financial management abilities by answering the relevant questions about their understanding of finances, ability to handle a bank account, and timeliness in paying bills.
  7. Determine whether the patient can direct the management of their funds for basic needs such as food and shelter. Provide a summary of your findings to support your conclusion.
  8. Conclude by assessing the patient's potential to manage their benefits in the future and explaining your rationale.
  9. Finally, review the completed form for accuracy, sign it as the medical source, and include the date of signing.
  10. You can save the changes made to the form, download it for your records, print it, or share it as needed.

Start completing your documents online for a seamless management experience.

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