Get Lupus (sle) Medical Source Statement 2009-2026

Completing the Lupus (SLE) Medical Source Statement is a crucial step in documenting the impairments of a person with lupus. This guide provides detailed, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the Lupus (SLE) Medical Source Statement online

1. Press the ‘Get Form’ button to access the Lupus (SLE) Medical Source Statement and open it in your preferred document editor.
2. Begin by entering the patient's name and social security number at the top of the form.
3. In the first section, indicate the frequency and length of your contact with the patient.
4. Respond to the question about whether the patient meets the diagnostic criteria for systemic lupus erythematosus (SLE), selecting 'Yes,' 'No,' or noting any other diagnoses.
5. Provide a detailed account of the clinical findings, laboratory and test results, and symptoms relevant to the patient’s condition. Include details for each item listed under the symptoms associated with SLE.
6. Identify any major organ or body system involvement using the provided list, marking those which apply.
7. Assess and indicate any functional limitations that the patient may experience in daily living activities and social functioning.
8. If emotional factors contribute to the patient’s symptoms, answer 'Yes' or 'No' to the corresponding question.
9. List any prescribed medications and treatments. Include potential side effects that may influence the patient's work capacity.
10. Complete the prognosis section with your professional assessment.
11. Answer whether the patient’s impairments are expected to last at least 12 months.
12. Estimate the patient’s functional limitations in a work environment, including how far they can walk, sit, or stand at a time.
13. Indicate any need for shifts in position during work and mention how often the patient may need unscheduled breaks.
14. Assess the patient’s ability to perform various activities and their limitations regarding environmental exposures.
15. Finally, provide a summary of any other limitations affecting the patient’s employability and sign the document.
16. Save the completed form and proceed to download, print, or share it as needed.

Take action now and complete your Lupus (SLE) Medical Source Statement online.