Social Security field offices send this report to the medical source of an adult who alleges HIV infection in a disability claim. The source documents the diagnosis and qualifying HIV-related findings, such as CD4 counts and opportunistic illnesses, so SSA can decide the claim and whether to start presumptive disability payments before the final decision. A separate form, SSA-4815, is used for children.
The treating physician or other medical source completes the medical sections and signs with name and title; signatures from a physician, nurse or other acceptable hospital or clinic staff are accepted. The claimant signs the short medical release at the top only if no SSA-827 is attached.
Download the current version from the source each time; forms change without notice.
Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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SSA's operations manual lets a field office make a presumptive disability finding when the medical source has checked a block in the manifestations section, completed at least one numbered item in the findings section, completed the required section, and signed with name and title. If the form falls short, State disability determination services can still make a presumptive finding from other medical evidence.
The medical professional completing the report signs and gives their title. SSA accepts signatures from a physician, a nurse or other acceptable staff at the hospital or clinic treating the claimant. If no SSA-827 authorization accompanies the form, the claimant signs the short medical release printed at its top.