Consultative Exam Notes Checklist worksheet
Use this checklist to organize appointment details, symptoms, medication, exam length, and follow-up concerns.
| Item | Your notes |
|---|---|
| Use This Checklist To Organize Appointment Details | ____________________________ |
| Symptoms | ____________________________ |
| Medication | ____________________________ |
| Exam Length | ____________________________ |
| Follow-Up Concerns | ____________________________ |
| Exam date | ____________________________ |
| Examiner | ____________________________ |
| Reason for exam | ____________________________ |
| Records brought | ____________________________ |
| Symptoms discussed | ____________________________ |
| Testing performed | ____________________________ |
| Functional observations | ____________________________ |
Before you use this checklist
- Copy dates and instructions from the current SSA notice rather than memory.
- Keep originals and work from copies.
- Do not send Social Security numbers, bank information, or full medical files to an unverified recipient.
- Save filing confirmations and proof of any time-sensitive submission.