Question: What suggestions do you have for completing an MSR when a client refuses to provide personal historical information (such as about family, friends, experiences, etc) and it appears related to their disorder?
If a person is guarded when you are interviewing them for the MSR, you can explain to them the importance of you gathering this information and providing it to Social Security as part of the SSI/SSDI application process. If they still don't want to provide you information then you can document in the MSR the person's guarded nature, their behavior and symptoms you observe, and document that you believe it to be due to the symptoms of their mental illness (paranoia, delusions, suspiciousness, etc.). You can try to obtain the information you need for the MSR from the person's medical records and if they are willing to sign ROIs, you can attempt to interview collateral sources such as family, friends, case managers, etc. to obtain information to include in the MSR.
Question: Should I actually include information from the Listings and Grids in the MSR, or should I wait until the applicant is denied?
The SAMHSA SOAR TA Center recommends that you don’t cite the Listing and Grid numbers, e.g.) Ms. Jones meets Listing 12.04, and the alternative Grid rule 203.03. Rather, at the DDS level (initial and reconsideration) we suggest providing a description of how the applicant meets a particular Listing(s) or Grid rule through specific examples from the medical records, applicant quotes, and other collateral sources.
Question: I have a client that has already applied for SSI, SSDI, and supplied his medical records to the SSA. Am I still able to help him with a MSR?
We recommend contacting the DDS examiner assigned to the case to find out where they are in the decision making process. If they have just been assigned the case and are starting to process it, then you have time to write and submit a Medical Summary Report. You could let the DDS examiner know that you have additional evidence to submit. If you do not have an SSA-1696 on file, the claimant will need to be with you when you call.
Question: Is there a sample MSR for adults with a physical disability?
Many of our sample MSRs include information about physical disabilities in addition to mental impairments. Here is an example of one.
We also encourage you to review the Listings for the specific criteria SSA will be looking for, for each condition. You'll want to include information in your MSR about how the person's conditions meet the listing criteria.
Question: I'm working with a client who has indicated that both her treating psychiatrist and her primary care doctor are willing to sign the MSR. Is there any advantage to having 2 signatures? Could this cause any issues?
It's great that she has two doctors willing to sign! Yes, we recommend including both signatures -- it sends a stronger message that they are both on board with the content. And it won't cause any issues.
Question: Is it necessary to have a psychiatrist conduct the Mental Status Exam (MSE) on an applicant or will a licensed social worker suffice?
The Mental Status Exam must be performed by an "Acceptable Medical Source" (AMS) in order to establish a "medically determinable physical or mental impairment."
Acceptable Medical Sources include physicians, psychologists, advanced practice nurse practitioners (APRN), or physician assistants (PA). Further, the APRN category includes: Certified Nurse Midwife, Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist. Audiologists are also acceptable medical sources for hearing-related disorders.
Licensed Clinical Social Workers (LCSWs) are not included.
Question: Can an Acceptable Medical Source (AMS) sign the Medical Summary Report if the client's main disabilities are mental but the AMS has mainly treated them for physical conditions?
Yes. By signing the MSR, the AMS is only indicating that they believe the included information to be true. It is likely that the provider has spoken with the individual about his/her mental illness, seen some records to that effect, and/or has witnessed some symptoms. In order to treat a patient properly for physical health conditions, the provider would need to be aware of medications and mental health treatment. If the doctor does not want to sign off on anything that does not pertain to their specific field of practice, they could sign a reduced MSR that does not include reference to the other treating sources, but does include reference to all of the conditions that the doctor feels comfortable attesting to.
Question: When the MSR is signed by an Acceptable Medical Source (AMS) is there any HIPAA concern if the MSR contains information from other treating providers?
An MSR that has been written based on properly released records can be shared with the primary AMS. At the point of obtaining the signature, it is primarily a privacy issue, not HIPAA. However, it would be a best practice to have a release signed by the applicant permitting the case worker to communicate with the AMS.
Question: If someone asks for a copy of their Medical Summary Report, do you give them a copy ?
The short answer is "yes." If someone asks to see their Medical Summary Report, you can provide it to them in the same manner that your agency would release a copy of their medical records to them.
However, there are some other factors to keep in mind. Since the MSR focuses on an applicant's symptoms and functional limitations rather than their strengths, we recommend talking with them first to explain that the report is written in this manner to demonstrate how they may be eligible for SSI/SSDI and that SSA needs to see numerous examples of their limitations. Remind them that they have a lot of personal strengths and that this report is not a full reflection of that.
It is important to speak with the applicant throughout the process in order to alleviate any concerns about what information will be included in the MSR. One best practice to establish transparency and trust is to ask permission on the first interview to take notes. Tell the applicant that at any time they can ask you to stop taking notes or to see what you are writing. Emphasize that your goal is to capture their words so that they can tell their story to SSA through this process. Ultimately, the MSR is comprised mainly of their quotes and information they have provided to you.
Reading about one's symptoms and limitations can be very difficult and through this conversation applicants may find that they aren't prepared for that or that it would not be beneficial for their recovery. But, if after this preparation, the applicant wants to read the MSR, then that is their right to do so, following your agency's guidelines.
Question: I cannot find the template or blank file for MSR. Should I just create a word document following the rubric?
The Medical Summary Report (MSR) Interview Guide and Template is a great tool for writing the MSR. The Interview Guide portion contains key questions to ask applicants when gathering evidence for the application. The Template contains main headings that may be used when formatting the MSR. Be sure to remove the Interview Guide and guidance under the Template headings before turning the MSR in to DDS. It is also important to put the MSR on your agency's letterhead whenever possible.