Disability Case Management Checklist Template
Simplify disability case management! Our checklist template ensures compliance, tracks progress, and delivers consistent outcomes-saving time and improving client care. Download now!
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Initial Assessment & Intake
Gathering initial information and determining eligibility.
Client Full Name
Date of Initial Contact
Referral Source (if applicable)
Client Age
Primary Disability Type
Brief Description of Presenting Concerns
Date of Birth
Documentation & Verification
Collecting and verifying supporting documentation.
Date of Application Received
Proof of Identity (e.g., Driver's License, Passport)
Social Security Card or Documentation
Social Security Number
Proof of Residency (e.g., Utility Bill, Lease Agreement)
Description of Disability and Functional Limitations
Type of Disability
Date of Disability Onset
Service Planning & Coordination
Developing a service plan and coordinating with relevant providers.
Primary Service Needs
Service Providers Involved
Service Plan Start Date
Service Plan Review Date
Service Plan Goals & Objectives
Estimated Service Hours/Week
Communication Method with Service Providers
Benefit Application Assistance
Assisting with applications for disability benefits (e.g., SSDI, SSI).
Benefit Program Applied For
Application Submission Date
Description of Barriers to Application
Estimated Income (Annual)
Supporting Documentation (e.g., Tax Returns)
Representation Status
Attorney Name (if applicable)
Medical Records Review
Reviewing medical records for eligibility and service needs.
Record Received Date
Summary of Medical History
Number of Physician Visits
Diagnosis Documentation
Relevant Medical Conditions
Uploaded Medical Records
Progress Monitoring & Reporting
Tracking progress towards goals and reporting to relevant parties.
Date of Progress Review
Progress Score (e.g., 1-10)
Summary of Progress Made
Challenges Encountered
Service Plan Adjustments Needed?
Notes on Service Plan Adjustments
Areas Requiring Further Support
Case Manager Signature
Next Review Date
Legal Advocacy & Support
Providing legal advocacy and support as needed.
Summary of Legal Issue
Type of Legal Assistance Provided
Date of Legal Action/Communication
Details of Communication with Legal Representatives
Supporting Legal Documents (e.g., correspondence, affidavits)
Outcome of Legal Action/Communication
Appeals & Hearings
Assisting with appeals and hearings related to disability benefits.
Appeal Filing Date
Reason for Appeal
Appeal Level
Supporting Documentation (e.g., Medical Records, Correspondence)
Appeal Reference Number (if applicable)
Hearing Date (if scheduled)
Hearing Time (if scheduled)
Case Closure & Transition
Properly closing the case and transitioning services.
Case Closure Date
Summary of Case Progress & Outcomes
Reason for Case Closure
Additional Notes/Comments
Final Documentation Upload (Optional)
Case Manager Signature
Compliance & Audit
Ensuring compliance with regulations and preparing for audits.
Last Compliance Review Date
Applicable Regulations (select all that apply)
Number of Audits Conducted This Year
Summary of Audit Findings
Audit Documentation
Corrective Action Plan Status
Date of Next Scheduled Audit
Case Management Screen Recording
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