Incapacity Determination - Acceptable Medical Evidence
DSHS Home Page
Search     for:

Incapacity Determination - Acceptable Medical Evidence

Revised December 30, 2013

Purpose: This section describes acceptable sources of medical evidence for HEN Referral incapacity determinations.

WAC 388-447-0005What evidence does the department consider to determine incapacity?

<p>WAC 388-447-0005

WAC 388-447-0005

Effective January 1, 2014

WAC 388-447-0005 What evidence does the department consider to determine incapacity?

We accept medical evidence from the following sources when considering incapacity:

(1) For a physical impairment:

(a) A physician, which includes:

(i) Medical doctor (M.D.); and

(ii) Doctor of osteopathy (D.O.);

(b) An advanced registered nurse practitioner (ARNP) for physical impairments that are within their area of certification to treat;

(c) A Physician's Assistant (P.A.);

(d) A Doctor of optometry (O.D.) for visual acuity impairments;

(e) Doctor of podiatry (D.P.) for foot disorders;

(f) Doctor of dental surgery (D.D.S.) or doctor of medical den-tistry (D.M.D.) for tooth abscesses or temporomandibular joint (TMJ) disorders; or

(g) The chief of medical administration of the Veterans' Admin-istration, or their designee, as authorized in federal law.

(2) For a mental impairment:

(a) A psychiatrist;

(b) A psychologist;

(c) An ARNP certified in psychiatric nursing; or

(d) At the department's discretion:

(i) A person identified as a mental health professional within the regional support network mental health treatment system provided the person's training and qualifications at a minimum include having a master's degree and two years of mental health treatment experience; or

(ii) A physician who is currently treating you for a mental im-pairment.

(3) We do not accept medical evidence from the medical profes-sionals listed in (1) and (2) above, unless they are licensed in Washington State or the state where the examination was performed.

(4) "Supplemental medical evidence" means information from a health professional not listed in (1) or (2) above who can provide supporting documentation for impairments established by a medical professional listed in (1) or (2) above. Supplemental medical evidence sources include:

(a) Health professionals who have conducted tests or provided ongoing treatment to you, such as a physical therapist, chiropractor, nurse, naturopath, audiologist, or licensed social worker;

(b) Workers at state institutions and agencies who are not health professionals and are providing or have provided medical or health-related services to you; or

(c) Chemical dependency professionals (CDPs) when requesting information on the effects of alcohol or drug abuse.

(5) "Other evidence" means information from other sources not listed above who can provide supporting documentation of functioning for impairments established by acceptable medical sources in subsections (1) or (2) of this section. Sources of "other evidence" include public and private agencies, schools, parents, caregivers, employers, and practitioners such as social workers.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

  1. Supplemental Medical Evidence may be used to help better understand the client's incapacities and make well-informed incapacity decisions.  Supplemental Medical Evidence does not replace Objective Medical Evidence (OME).  OME must still be obtained for the Progressive Evaluation Process.
Modification Date: December 30, 2013