CSD Mental Incapacity Evaluations

Purpose
The Department of Social and Health Services (DSHS), Community Services Division (CSD), provides multiple programs to support the mission of DSHS. The purpose of this Request for Qualification (RFQ) is to expand the list of qualified psychologists and psychiatrists to use their diagnostic and clinical expertise to evaluate a client’s claimed mental impairment. 
Contact Name
Daisha Gomillion, Program Manager
Contact Email and Address
Daisha.Gomillion@dshs.wa.gov
Department of Social and Health Services
Economic Services Administration
Community Services Division
P.O. Box 45470
Olympia, WA 98504-5470
Contact Phone and Fax
(360) 725-4781 - Office
(360) 725-4904 - Fax
Submissions
If you are interested in providing consultative services, please submit your application packet to the above address or fax number.

Documents

RFQ # 1436-522 ESA Medical and Psychological Services
       CSD Mental Incapacity Evaluations - Request for Qualification; Update 7/27/2016

  • Exhibit A – Application Checklist
  • Exhibit B – Statement of Agreement Form
  • Exhibit C – Contractor Intake Form
  • Exhibit D – Sample Contract – CSD Mental Incapacity Evaluations
  • Exhibit E – Applicant Certification and Assurances Form