South carolina dss form social services 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I, where a DSS employee fills in the patient's name, date of birth, last four digits of their Social Security number, case name, and case number. Ensure all fields are accurately completed.
3. Move to Section II, which must be filled out by a physician. Here, the physician will provide details about the patient's disability prognosis and work capabilities. They should check appropriate boxes regarding the patient's ability to work and any restrictions.
4. In Part B of Section II, indicate specific activity restrictions by checking applicable boxes for tasks like sitting or lifting. This section helps clarify what the patient can manage during a workday.
5. Complete Part C with primary and secondary diagnoses along with comments from the physician. The physician must sign and provide their contact information.
6. Finally, Section III is for the client to authorize their medical provider to release information. Ensure that this section is signed and dated appropriately.

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