130.20—Form of medical documentation.
In all instances in which medical documentation is referred to, medical documentation may be submitted in the following forms:
(a)
Copies of relevant portions of medical records, records maintained by a physician, nurse, or other licensed health care provider, test results, prescription information, or other documentation deemed credible by the Secretary; or
(b)
An affidavit, signed under penalty of perjury, by a physician, nurse practitioner or physician assistant, verifying that the medical criteria necessary for a petitioner to be eligible for payment under the Act are satisfied. Such an affidavit must include the physician's, nurse practitioner's or physician assistant's State of practice, and license, certification or registration number, as applicable. A sample affidavit is set forth at Appendix B to this part.
(Approved by the Office of Management and Budget under control number 0915-0244)
[65 FR 34864, May 31, 2000, as amended at 66 FR 58671, Nov. 23, 2001]