Form SSA-4814. Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection

Form SSA-4814, the Medical Report on an Adult with an Allegation of Human Immunodeficiency Virus (HIV) Infection, is used to report medical information regarding an adult who alleges having HIV infection. The primary purpose of this form is to collect medical information to determine eligibility for HIV infection-related Social Security disability benefits.

An individual who is applying for Social Security disability benefits due to an allegation of HIV infection can use this form to provide medical documentation to support their claim. The purpose is to assess the medical evidence to determine eligibility for HIV-related disability benefits.

The parties involved are individuals alleging HIV infection, healthcare providers, and the SSA. The form typically includes sections for reporting detailed medical information about the individual's HIV diagnosis and related conditions. Accurate and comprehensive medical documentation is crucial when filling out this form to establish eligibility for benefits.