Aged, Blind, Disabled (ABD): How to Complete the Medical Social Summary (08MA022E)

All sections must be filled out before sending to LOCEU (Level of Care Evaluation Unit). It is very important that no section be skipped. Workers should get with clients to get the answers for all the blocks.

Case Information

  • Case name: Payee’s name
  • Case Number
  • County Name and Number
  • Mailing Address

Case Status Information

  • What kind of determination is needed:
    • Application with application date,
    • Annual review with review due date,
    • Reconsider a denial with date of denial from MDL
    • Information requested by LOCEU on [date worker sent documents to LOCEU] requested by [initials from MDI] on [date from MDI]
  • Type of categorical relationship request: Is this to establish a
    • Disability status for ABD-related benefits or
    • Incapacity for a TANF case
    • Alien Emergency Services
  • Requested approval date; earliest month for which decision is needed
  • Interview date

Information Regarding Person Requesting a Disability or Incapacity Decision

  • Identifying Information
    • Person’s name
    • Client Identification Number: Recipient ID number for SoonerCare (on the PY screen)
      • Under “DATA FROM ALFX/CLIENT DATA BASE” the 9 digit number on the line showing
      • “CLIEN” under “SRC” or person’s EF page, second page bottom right side
    • Date of birth; SSN; Marital status; Gender; Hispanic or Latino; Race
    • U.S. citizen or alien status
      • If an alien, check the appropriate box (make sure the coding in FACS matches what you mark)
    • Number of minor dependents

Disability Eligibility

  • Basis for disability request: Why do you need LOCEU to make the requested decision?
  • Federal disability information: Has the client applied for or been approved /denied for SSI or RSDI? Check all boxes that apply
    • Approval Date: If the client has been approved for SSI, enter the SSI Eligibility Date from SDX. If the client is approved for RSDI, enter the date from the Disability Onset Date from BENDEX. If you have the approval letter from Social Security, enter the disability onset date from the letter.
    • Last Denial date: Enter the date from the SSI Eligibility Date block in SDX or the letter from Social Security Administration
    • Pending [decision from SSI or RSDI]
  • Ineligible for SSI due to income? (N01 closure or denial code on SDX)
  • Medical service prior to SSI approval
    • If yes, enter date(s) of service
  • Approval for veterans benefits based on disability?
    • If waiting for a disability decision from VA, get the date paperwork was submitted to request the decision.
  • Applying for nursing home or waivered services?
  • Child applying for TEFRA?
  • Primary and Secondary Diagnosis. Should be on doctor statement, medical documents, etc.

Education and Training Information

This information helps in determining the client’s continued ability to find gainful employment. Could the client perform a different task despite impairment? Ex: client has a degree, but has worked as a roustabout for the past few years. It is important that this information be provided.

  • Highest grade completed; vocational or technical training, licenses or degrees
  • Literacy Skills: check the box that best describes the client’s reading ability
  • Ability to communicate in English
  • Does the person drive a car?
  • Work History: fill in as completely as possible with information from the client

Health Issues

  • Do you have a work release from the doctor?
  • Does doctor recommend work restrictions?
  • Describe behavior problems: as much detail as possible
  • Describe environmental restrictions: details, such as: is the client unable to take sudden loud noises, must use a wheelchair or walker, etc.
  • Describe an employment related barriers due to health issues: Why can’t the client perform substantial gainful activity? For instance, a person in a wheelchair might be able to work a desk job, but they probably wouldn’t be able to work on a construction site. This question is, based on the client’s work history and education, how does their diagnosis keep them from performing tasks they have handled in the past? What aspects of their work history will be barriers going forward? Give as much detail as possible.
  • When the person is caring for a dependent living in the home, describe any health issues that affect that person’s ability to care for the dependent? Give as much detail as possible.
  • Describe any special care needed by a child in the household: give as much detail as possible.
  • List the hours and minutes the person spends doing the following activities in a typical 12 hour period. Use the client’s best estimates.

Additional Information

  • Anything the worker or the client thinks LOCEU needs to know about the client’s condition or limitations that could help in making the decision.

Worker Recommendation

  • Based on the worker’s observations, does there seem to be a severe enough impairment to keep the client from pursuing substantial gainful activity? If there was not enough information obtained in the interview, check “no recommendation?”

Mail the form and medical records to the address on the front of the form. The majority of office cannot use Interagency Mail to send these to OHCA. Make sure to put a copy in Imaging just in case the documents don’t get to OHCA.

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