Sample letter to Social Security Administration on behalf of patient
A template letter is included below. This page is also available for download as a PDF document.
Today's Date
RE: Patient's Name, Case Number (if available)
To Whom It May Concern:
I am contacting you on behalf of my patient, Patient's full name. Patient's name is currently applying for disability and asked me to provide this statement about his/her medical diagnosis and physical condition.
Psoriasis is a chronic, life-altering and often debilitating condition for which there is no cure. Ten percent to 30 percent of people with psoriasis also develop psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints. Although these conditions reveal themselves on the skin and in the joints, there is also a powerful negative effect on mental functioning. Researchers have found that psoriasis causes as much disability as other major diseases, such as cancer, arthritis, hypertension, heart
disease, diabetes and depression.
Patient's name suffers from (list conditions). As a result of this/these condition(s), he/she should be considered disabled. Patient name's ability to perform a number of basic tasks is limited. Describe how the patient's condition affects his/her:
Ability to work:
- How has the patient's condition compromised his/her ability to perform tasks in the
workplace?
Overall mobility:
- Does the patient have difficulty standing or walking for extended periods?
- Has psoriatic arthritis compromised his/her manual dexterity?
- Can the patient reach overhead, bend over or lift heavy items?
- Can the patient perform routine or repetitive tasks?
Psychological state:
- Does the patient suffer from depression or another psychological condition?
If you have any further questions regarding this patient, please do not hesitate to contact me.
Sincerely,
Physician Name
Physician Address
City, State ZIP Code
Phone Number
Cc: Name of Patient
National Psoriasis Foundation
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