Request for Qualifications 1236-426 DDDS Consultative Medical Examinations
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Purpose
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The Department of Social and Health Services (DSHS), Division of Disability determination Services (DDDS), administers the Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and DSHS Non-Grant Medical Assistance programs. The purpose of this Request for Qualifications (RFQ) is to expand the list of qualified, contracted physicians to perform medical examinations for clients who apply for these benefits.
* As of 12/17/12, we are not accepting applications in Kitsap County, Pierce County, Portland (Oregon), Seattle, Skagit County, Snohomish County, Vancouver, or Whatcom County. |
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Contact Name
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Uyen Kashani, Professional Relations Specialist |
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Contact Email and Address
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Uyen.Kashani@ssa.gov Department of Social and Health Services Division of Disability Determination Services P.O. Box 9303 Olympia, WA 98507-9303 |
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Contact Phone
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1-800-562-6074, Ext. 47437 |
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Contact Fax
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(360) 664-7359 |
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Submissions
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If you are interested in becoming a Consultative Examiner, please submit your application packet to the above address or fax number. |
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Issue Date
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October 26, 2012 |
Documents
RFQ 1236-426 - Legal Notice - October 26, 2012
RFQ 1236-426 - Request for Qualification
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Exhibit A - Application Checklist
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Exhibit B - Acknowledgement of Professional Qualifications & Confidentiality
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Exhibit C - Statement of Agreement for Medical Providers
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Exhibit D - Contractor Intake Form
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Exhibit E - Sample Contract – Consultative Medical Examination
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Exhibit F - Cardiac Specialty Examination
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Exhibit G - Neurological Specialty Examination
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Exhibit H - Orthopedic Specialty Examination
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Exhibit I - Respiratory Specialty Examination
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Exhibit J - Rheumatology Specialty Examination
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Exhibit K - Medical Source Statement of Ability to do Work-Related Activities
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