Electronic Records Express

www.socialsecurity.gov

Help Desk: 1-866-691-3061

Prepare CE Report for Provider

Preparation (Step 1 of 3)

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Provider Information:
Select the provider for whom this CE Report is being prepared.

Provider:

Patient Information:
Enter the Patient's Information.

First Name:

Middle Name:

Last Name:

DOB: (mm/dd/yyyy)

Enter 3 character site code or select state and destination:

Site code: OR State:

Destination:

Enter the following information from the request letter or barcode:

SSN:

RQID (Request ID):

RF (Routing Field):

- P D or blank No RF or No Barcode

DR:

- F S No DR or No Barcode

CS:

(enter only if applicable)