Debunking Forms: The Medical Source Statement (Mental)

As we mentioned in the last post, we will be doing a series on Social Security Administration (SSA) forms during the month of March to help you apply for disability benefits with confidence.

While we’ve already covered the physical version of the Medical Source Statement, today we’ll be addressing the Medical Source Statement – Mental (Form HA-1152-U5). This will be used if your disability is more psychological or mental in nature and must be filled out by your physician or therapist. If you are represented by an attorney, he or she will present this form to your healthcare provider.

This form focuses on your ability to perform work-related activities on a day-to-day basis, addressing specific functions. It’s important to provide detailed information about your condition to your physician or therapist so he or she can answer accurately.

Functions that will be addressed include: occupational adjustments (i.e. following rules, getting along with superiors and colleagues, public interaction, stress, and concentration); performance adjustments (how your attention to detail, memory, comprehension, thought organization, and intellectual ability can handle job instructions); and social adjustments.

You can find this form on the SSA’s website or by visiting your local Social Security office.

If you are interested in legal representation to help you approach the application process with confidence, please contact the experienced staff of Jan Dils Attorneys at Law today.