Get Ssa-4815 2023-2026

The SSA-4815 is a crucial document utilized by the Social Security Administration to collect medical information regarding a child with an allegation of human immunodeficiency virus (HIV) infection. Completing this form accurately can help in securing timely disability payments for your child.

Follow the steps to effectively complete the SSA-4815 online.

1. Press the ‘Get Form’ button to download the SSA-4815 and open it in your preferred online editor.
2. Provide the identifying information in Section A, including the claimant's name, Social Security number, phone number, address, date of birth, and the name of the medical source.
3. In Section B, detail how the HIV infection was diagnosed, indicating if it was through laboratory testing or other clinical findings.
4. Move to Section C and check any applicable conditions related to the HIV infection. Ensure all information is documented in the medical records, as it will be required for case adjudication.
5. Complete Section D with any remarks or additional comments regarding the patient’s condition.
6. Fill in Section E with the medical source's name and address, including a contact telephone number and the date.
7. Finally, in Section F, sign and date the form to affirm all information is accurate. Make sure the form is complete before saving, downloading, printing, or sharing.

Take action today and complete the SSA-4815 online.