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Sample Psychologist-to-SSA Letter

Sample Psychologist-to-SSA Letter This Sample Letter is designed as a guide to help you draft a personalized medical report documenting mental impairment. [Psychologist s Name] [Street Address] [City, ST ZIP] [DATE] [Recipient Name] [Title] [Company Name] [Street Address] [City, ST ZIP] Re: [Patient Name; Date of Birth; SSN] To Whom It May Concern: My patient [NAME] has [MS diagnosis and relevant condition] that is severe. The neurological problems caused by the MS have been documented elsewhere by [his/her] physician. [HE or SHE] is limited in daily activities and is unable to work on a sustained basis. I have interviewed [NAME] and administered a battery of standardized neuropsychological tests, including [FULL LIST OF TESTS, DATA, AND RESULTS]. [NAME] has at least two specified impairments, including: (PROVIDE EXAMPLES) Loss of previously acquired functional abilities.

Memory impairment (reference memory tests). Loss of intellectual ability (reference education and occupation history, test scores, and change in IQ). Marked restrictions of activities of daily living and sustained work (reference function affected, such as …

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