Arizona Sample Letter for Medical Records Release in Social Security Disability Action
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FAQ
This form is to authorize a medical doctor or nurse practitioner to release medical information.
You can get your Social Security Statement (Statement) online by using your personal my Social Security account. Your online Statement gives you secure and convenient access to estimates for retirement, disability, and survivors benefits you and your family may be eligible for.
SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled.
The following instructions are for completing the preprinted paper Form SSA-3368 (Disability Report ? Adult). The Disability Determination Services (DDS) uses the information on the 3368 to develop medical and other evidence that can be used to establish the correct onset date.
A medical source statement is a form completed by your doctor summarizing how limited you are physically and mentally as a result of your conditions. This document will help the SSA determine whether you are disabled.
You may call the Social Security Electronic Records Express Help Desk at 1-866-691-3061 or send them an email at electronic-records-express@ssa.gov, or you should contact the office where you are sending the document or the office that requested the information.
The United States Social Security Administration. | SSA.
