How to Complete DSS Form 1247: South Carolina Medical Release Form

DSS Form 1247 is South Carolina’s Medical Release and Physician’s Statement, the form your doctor fills out so the Department of Social Services can decide whether a physical or mental condition limits your ability to meet the work requirements attached to TANF or SNAP benefits.¹ It has three sections: one your caseworker fills in, one you sign to authorize the release of medical information, and the main clinical section your physician completes.

Signing the form is voluntary. You don’t have to sign it to keep your benefits, but you do have to sign it if you want DSS to exempt you from work participation requirements. Without a completed form, DSS treats you as work-eligible.¹

What the Form Can Exempt You From

For TANF recipients, South Carolina’s Family Independence Act expects adults to participate in work or work-preparation activities. A completed Form 1247 can support an exemption if a physician verifies that a physical or mental impairment prevents you from working, attending education programs, or participating in training. DSS may also request a confirming assessment through the South Carolina Department of Vocational Rehabilitation if it considers the physician’s findings unclear.²

For SNAP, the form serves a different rule. Able-Bodied Adults Without Dependents (ABAWDs) face a work requirement, and failing to meet it can cost you food assistance. A physician’s certification on Form 1247 that you are physically or mentally unfit for employment can satisfy an exception to the ABAWD rule or a broader exemption from SNAP work requirements.¹

The form is also used to determine whether a TANF recipient qualifies for the Challenging Adults through Rehabilitation, Education and Services (CARES) program.¹

How to Fill Out DSS Form 1247

Three people complete three sections. The order on the page (I, II, III) is not the order you actually do them. You sign your authorization first so the doctor has permission to release information before recording anything.¹

Section I: Your Caseworker

Your DSS caseworker fills this in before giving you the form. It ties the form to your case: patient name and date of birth, the last four digits of your Social Security number, case name and case number, county, and the DSS employee’s name, phone, fax, and office mailing address. If you receive a blank form without Section I completed, ask your caseworker to fill it in before you take it to your doctor.

Section III: Your Authorization

Complete this before the doctor’s appointment. Signing Section III authorizes a specific doctor, facility, or health care provider to complete the physician’s portion and release that information to DSS.¹ Enter your name, the name of the provider you’re authorizing, and an expiration date for the authorization, then sign and date it. If someone else signs for you, they must describe their authority to act on your behalf. If you can’t write a signature, you may mark an X, but two witnesses must sign and date the form alongside the mark.

Section II: Your Physician

This is the clinical core of the form and has three parts.

Part A asks the physician to select a prognosis: permanent disability, temporary lasting more than 90 days with a written expected duration, or temporary lasting less than 90 days with a written expected duration. The doctor then indicates your work capacity, ranging from full-time work without restrictions (40 hours per week), to part-time work with or without restrictions, to being unable to work or participate in preparation activities at all. If you are pregnant, the doctor notes the estimated delivery date and any medical limitations affecting work, school, or training.

Part B is used only if you can work with restrictions. It spells out what you can and cannot do during a workday. The doctor checks activities such as sitting, standing, walking, climbing stairs, kneeling, bending, pushing, pulling, keyboarding, and lifting, and marks the maximum hours per workday for each (2, 4, 6, or 8). A separate field captures the maximum weight you can lift or carry and for how long. There’s room for remarks on restrictions the checkboxes don’t cover.

Part C records the primary disabling diagnosis, any secondary diagnosis, and additional comments. The physician signs, dates, and provides an office address and phone number.

Getting the Physician’s Section Filled Out Well

The most common problem with Form 1247 is a doctor who fills it out too vaguely for DSS to act on. A prognosis that just says “back pain” with no functional limitations gives the caseworker nothing to work with. Before the appointment, think through the specific ways your condition affects daily activity: how long you can stand, how much you can lift, whether you can sit at a desk for extended periods. Bring those details to your doctor so Part B reflects your actual limitations.

If your condition is temporary, make sure the physician writes a specific expected duration on the length-of-disability line. DSS uses that timeframe to set the length of your exemption. A missing duration can lead to a shorter exemption or a request to resubmit the form.

Keep a copy of the completed form before it goes to DSS. If a dispute over your work requirements or exemption status comes up later, having your own copy saves time.

Where to Submit the Form

The completed form goes to the DSS county office managing your case. The mailing address, phone, and fax number for that office are pre-printed in Section I by your caseworker.¹ Your physician can either return the form to you for delivery or send it directly to DSS.

Hand delivery to your local county office lets you confirm receipt on the spot.
Mail to the address in Section I; certified mail gives you a delivery receipt.
Fax to the number in Section I; keep the confirmation page as proof of transmission.

If you don’t know which office handles your case, the DSS contact page lists every county location.³ The state office at P.O. Box 1520, Columbia, SC 29202-1520 is not where your form should go; use the county office listed on your form.

What DSS Does After You Submit

Your caseworker reviews the physician’s findings and decides whether the medical evidence supports an exemption. If the physician certified that you cannot work at all and DSS accepts the certification, you’ll be exempted from work participation for the duration the doctor listed. If the doctor indicated you can work with restrictions, DSS uses the Part B activity limits to identify participation activities that fall within your capacity, so you may still be expected to participate in a modified way.¹

DSS can request a confirming assessment through the South Carolina Department of Vocational Rehabilitation if it considers the physician’s statement insufficient or unclear.² That’s a second evaluation, not a rejection.

For a temporary disability, the exemption ends when the doctor’s estimated duration runs out. If the condition persists, you’ll need a new Form 1247; otherwise, you’ll be expected to resume meeting work requirements. Track the expiration date your doctor wrote so you don’t fall into a gap.

When You Need Form 1247-A Instead

If the reason you can’t work is that you provide full-time care for a disabled family member in your home, the form you need is DSS Form 1247-A, “Medical Release/Physician’s Statement: Required In-Home.”⁴ Form 1247 is about your own disability; Form 1247-A is about caring for someone else’s. Caring for an incapacitated family member whose condition is verified by a physician is a separate exemption under South Carolina law.² Your caseworker can confirm which form applies.

Where to Get a Blank Copy

Your caseworker will normally hand you Form 1247 with Section I already completed. If you need a blank copy, it’s posted as a PDF in the forms and brochures section of the South Carolina DSS website, and you can pick one up at any county DSS office.¹ If you download it yourself, remember Section I still has to be filled in by DSS staff before the form is valid.

1
South Carolina Department of Social Services. DSS Form 1247
2
South Carolina Legislature. South Carolina Code Title 43 Chapter 5
3
South Carolina Department of Social Services. Contact DSS
4
South Carolina Department of Social Services. DSS Form 1247-A