Fillable medical source statement of ability to do work-related activities - DSHS - dshs wa
SOCIAL SECURITY ADMINISTRATION
OFFICE OF DISABILITY ADJUDICATION AND REVIEW
MEDICAL SOURCE STATEMENT OF
ABILITY TO DO WORK-RELATED ACTIVITIES (PHYSICAL)
NAME OF INDIVIDUAL
SOCIAL SECURITY NUMBER
To determine this individualâ€™s ability to do work-related activities on a regular and continuous...
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