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Fillable medical source statement of ability to do work-related activities - DSHS - dshs wa

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SOCIAL SECURITY ADMINISTRATION OFFICE OF DISABILITY ADJUDICATION AND REVIEW Form Approved OMB No.0960-0662 MEDICAL SOURCE STATEMENT OF ABILITY TO DO WORK-RELATED ACTIVITIES (PHYSICAL) ================================================================================== NAME OF INDIVIDUAL SOCIAL SECURITY NUMBER To determine this individual’s ability to do work-related activities on a regular and continuous...
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