Get Ssa-3826-f4 2008-2025

Filling out the SSA-3826-F4 form is an essential step in processing medical reports for Social Security claims. This guide provides clear instructions to help you successfully complete the form online and ensure that all necessary information is accurately submitted.

Follow the steps to fill out the SSA-3826-F4 online:

1. Press the ‘Get Form’ button to access the SSA-3826-F4 form and open it in your preferred online document editor.
2. Enter the patient's details. Fill in the patient's Social Security number, name, and date of birth accurately.
3. If applicable, include the wage earner's name if it differs from the patient’s name.
4. Input the name and address of the requesting office as required.
5. Document the information of the medical source by noting the name and contact information.
6. Complete the history section. Specify the date of the first examination, the date of the most recent examination, and the frequency of visits.
7. Fill out the medical findings section. List the patient’s height and weight, and include any relevant medical findings along with dates.
8. In the laboratory and special studies section, provide results of all pertinent studies conducted, including the dates.
9. Outline the diagnoses in the designated section, numbering each diagnosis accordingly.
10. Document the treatment and response of the patient as required.
11. If applicable, answer the question regarding the patient’s ability to manage funds. Provide an explanation if the answer is 'No'.
12. Type or print the reporting medical source's name and address.
13. Ensure to include the signature, title, telephone number, and the date in the appropriate fields.
14. Once all fields are completed, review the form for accuracy, then save your changes, and choose to download or print the form as needed.

Complete your forms online to ensure timely processing of your claims.