Fillable medical source statement of ability to do work-related activities - DSHS - dshs wa
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 To determine this individual s ability to do work-related activities on a regular and continuous basis please give us your opinion for each activity shown below The following terms are defined as...
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