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For customers who submit Medical Forms but who are not determined to be blind or disabled, the Medical Review Team (MRT) maintains the Medical Form within the MRT suite, which is a secure, employees-only area at 645 H St, NE. During business hours, the suite is staffed with a dedicated receptionist who controls access to the single entrance to the work area. After hours, the suite is locked, and non MRT staff members are not able to access that work area until the following morning when the MRT re opens.

ROUTINE DISCLOSURES OF CUSTOMER INFORMATION 3.6

Disclosing Customer Information to the Customer or Authorized Representative 3.6.1

ALL Customers or their authorized representative(s) may request to review their own personal case record. SSRs should record any and all such disclosures in the case narrative (see below). However, SSRs shall under no circumstances disclose any customer information to an unidentified individual or to an unauthorized person. Please see Section 1.3: “General Rights of Applicants and Recipients” in this Part. To disclose such information to the customer, the SSR must first conclusively identify the customer by asking them to provide their correctly spelled name, date of birth, Social Security Number, and other information as appropriate. If the request is in writing, the SSR must compare the customer’s signature with that on the application and/or recertification forms contained in the case record. To disclose such information to an authorized representative, the SSR must conclusively identify the representative as an individual listed as an authorized representative on: • the Authorization for Release of Information form (DHS Form 495-ARI); • the most recent application/recertification form; • an authorization or release, which is signed by the customer, from an attorney, legal advocate or other representative; or • the ADD2 screen in ACEDS. If the request from the customer is in writing, the SSR may need to contact the authorized representative in order to confirm the identity of the person requesting the customer’s information. At the time of any disclosure, the SSR should note in the case narrative the following information: 1. the date of the disclosure 2. the name of the entity or person who received the information and, if known, the address of such entity or person; 3. a brief description of the information disclosed; and 4. a brief statement of the purpose of the disclosure that reasonably documents the basis for the disclosure or, in lieu of such statement, a copy of a written request for a disclosure, if any. In all circumstances, the SSR should release only the minimum necessary information to accomplish the purpose of the disclosure or request. The SSR should not disclose information that is peripheral, incidental or unrelated to the specific request or inquiry. If an SSR has questions about the appropriateness of releasing information, they should contact the IMA Policy Unit for further guidance. If the requestor is not listed on any of the documents above or on the ADD2 screen in ACEDS, the representative must produce a signed request by the customer asking that the information be released to the representative. Again, the SSR should compare the customer’s signature with that on the application and/or recertification forms contained in the case record. In the event that the customer is