Disability Report--Appeal (EDCS)

IAPPEALS REVITALIZATION

EDCS 3441
SCREEN MOCK-UPS
VERSION 4.0

1

Table of Contents
1. Screen Designs .................................................................................................................................................... 3
1.1. 3441 About You ........................................................................................................................................... 3
1.2. 3441 Contacts .............................................................................................................................................. 4
1.3. 3441 Medical Conditions ............................................................................................................................. 5
1.4. 3441 Medical Sources .................................................................................................................................. 6
1.5. Doctor/HMO/Therapist Information ........................................................................................................... 7
1.6. Hospital/Clinic Information.......................................................................................................................... 8
1.7. 3441 Other Medical Information ................................................................................................................. 9
1.8. Other Medical Information Detail ............................................................................................................. 10
1.9. 3441 Medicines Summary ......................................................................................................................... 11
1.10. Medicine Information .............................................................................................................................. 12
1.11. 3441 Tests Summary ................................................................................................................................ 13
1.12. 3441 Activities .......................................................................................................................................... 14
1.13. 3441 Work and Education ....................................................................................................................... 15
1.14. Test Information ...................................................................................................................................... 16
1.15. 3441 Vocational Rehabilitation, Employment, or Other Support Services ............................................. 17
1.16. Vocational Rehabilitation, Employment, or Other Services Information ................................................ 18
1.17. 3441 Remarks .......................................................................................................................................... 19
1.18. Screen Mock-up Version Information...................................................................................................... 20

2

1. Screen Designs
1.1. 3441 About You

3

1.2. 3441 Contacts

4

1.3. 3441 Medical Conditions

5

1.4. 3441 Medical Sources

6

1.5. Doctor/HMO/Therapist Information

7

1.6. Hospital/Clinic Information

8

1.7. 3441 Other Medical Information

9

1.8. Other Medical Information Detail

10

1.9. 3441 Medicines Summary

11

1.10. Medicine Information

12

1.11. 3441 Tests Summary

13

1.12. 3441 Activities

14

1.13. 3441 Work and Education

15

1.14. Test Information

16

1.15. 3441 Vocational Rehabilitation, Employment, or Other Support Services

17

1.16. Vocational Rehabilitation, Employment, or Other Services Information

18

1.17. 3441 Remarks

19

1.18. Screen Mock-up Version Information
Version
Number

Date

Content Revisions

Page
#

Revised
by

1.0

2/28/14

Version 1.0

Beth
Candella

2.0

3/5/14

Updated Section 1.15 Vocational Rehabilitation screen mock-up

17

Beth
Candella

3.0

3/25/14

Updated Section 1.13 Work and Education screen mock-up with new wording per ODP

15

Beth
Candella

4.0

3/27/14

Updated Section 1.15 Vocation Rehabilitation to remove “COMPLETE THIS
SECTION…”

17

Beth
Candella

20