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Physical Functional Evaluation 1. Payment for a general or comprehensive physical evaluation is contingent upon receipt of available chart notes from within the past six months, as well as supporting

How to fill out dshs physical functional evaluation

How to fill out dshs physical functional evaluation?

1. Begin by carefully reading through the instructions provided with the dshs physical functional evaluation form.
2. Gather all the necessary information and documents required for the evaluation, such as medical records and any relevant test results.
3. Start filling out the form by providing your personal information, including your name, address, contact details, and date of birth.
4. Progress to the medical history section and provide accurate details about any previous illnesses, injuries, surgeries, or medical conditions you have experienced.
5. Move on to the section specifically related to your current condition or disability. Provide a comprehensive description of your symptoms, limitations, and any activities that you struggle with due to your condition.
6. If applicable, fill out the section regarding your medications, including the names, dosages, and frequency of any prescribed drugs you are taking.
7. The next section typically covers your mobility and physical functioning. Be thorough in explaining any difficulties you face in walking, standing, sitting, lifting, or performing household tasks.
8. Proceed with detailing any visual, hearing, or speech impairments you may have, and describe how these limitations affect your daily life.
9. If required, provide information about any assistance or accommodations you may need to aid your mobility or physical functioning, such as assistive devices or home modifications.
10. Make sure to review your completed form for any errors or omissions before submitting it.

Who needs dshs physical functional evaluation?

1. Individuals who are applying for or are receiving benefits from the Department of Social and Health Services (dshs) may need to undergo a physical functional evaluation.
2. Individuals with disabilities or medical conditions that impact their ability to work, perform daily activities, or maintain a certain level of independence may be required to undergo this evaluation.
3. The evaluation helps determine an individual's level of physical functioning and any limitations they may have, which will aid in assessing their eligibility for specific benefits or services provided by dshs.

People Also Ask about dshs physical functional evaluation

How do I contact DSHS in Washington state?

Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service.

What is the phone number for renton DSHS?

The following services can be completed in the office or online or by phone at 877-501-2233: Apply for benefits or submit documents.

What is DSHS in Washington state?

Washington State Department of Social and Health Services.

What is the phone number for the Washington Connection DSHS?

Call us between 8AM and 3PM, Monday through Friday, at 1-877-501-2233; or. Visit us in person from 8AM-3PM, Monday through Friday at any local office. You can use the office locator to find your local DSHS Community Services Office.

What are three services Washington State provides to citizens?

Economic Services Administration Community Services Office. Division of Child Support. Office of Refugee and Immigrant Assistance. Disability Determination Services.

How do I speak to someone at EBT Washington State?

Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service. Apply for benefits or submit documents. 9 a.m. to 4 p.m.: Pick up an EBT card in the office.

Who do I call for food stamps in Washington state?

You can apply for Basic Food Assistance online, by phone at 877-501-2233 or at your local Community Services Office.

What is the P EBT customer service number in Washington state?

Families who aren't active on Basic Food assistance are encouraged to apply for food assistance by completing an application online at Washington Connectionor calling the Customer Service Contact Center at 877-501-2233.Households newly approved for Basic Food will be automatically reviewed for P-EBT eligibility in

For pdfFiller’s FAQs

What is dshs physical functional evaluation?

DSHS (Department of Social and Health Services) typically refers to the state agency responsible for providing social and health-related programs and services in Washington State, USA. However, there is no specific mention of a "DSHS physical functional evaluation" in their official resources or services. It is possible that you may be referring to a different agency or program. If you can provide more context or details, I would be happy to assist you further.

Who is required to file dshs physical functional evaluation?

The DSHS (Department of Social and Health Services) physical functional evaluation is typically required for individuals who are applying for or already receiving disability benefits, such as those provided by Medicaid or Social Security. The specific requirements and criteria for filing this evaluation may vary depending on the state and the particular program being applied for. It is best to consult with the relevant government agency or disability benefits coordinator for accurate and specific information regarding the filing requirements for a DSHS physical functional evaluation.

How to fill out dshs physical functional evaluation?

To fill out the DSHS (Department of Social and Health Services) Physical Functional Evaluation form, follow these steps: 1. Start by reading the form carefully to understand the purpose and requirements of each section. Take note of any specific instructions or additional documents that need to be included. 2. Begin with the personal information section. Fill in your name, address, contact details, Social Security number, and any other requested details. 3. Move on to the medical history section. Provide accurate and comprehensive information regarding any past or present medical conditions, surgeries, hospitalizations, medications, and treatments. You may need to attach additional medical records or reports to support your responses. 4. Complete the functional assessment section. This part requires you to assess your abilities to perform everyday activities such as walking, sitting, standing, lifting, bending, reaching, grasping, and other physical tasks. Indicate if you have any limitations or difficulties in performing these activities and provide details if required. 5. If applicable, describe any assistive devices or equipment you use to aid in your mobility or self-care. 6. Clarify any restrictions or limitations you have in work-related activities, such as walking long distances, carrying heavy loads, or performing specific tasks due to your physical condition. 7. If you have any limitations or restrictions related to activities of daily living (ADLs) such as bathing, dressing, grooming, eating, and using the restroom, provide details in the appropriate section. 8. Include any relevant medical documentation or reports that support your functional limitations or disability. These may include doctor's letters, imaging results, physical therapy reports, or other relevant records. 9. Review the completed form for accuracy and completeness. Make sure all sections are filled out correctly and legibly. 10. Sign and date the form to indicate your agreement with the provided information. 11. Make copies of the completed form and any supporting documents for your own records. 12. Submit the form to the appropriate DSHS department or office by mail, fax, or in-person delivery, as per their specific instructions.

What is the purpose of dshs physical functional evaluation?

The purpose of the DSHS (Department of Social and Health Services) physical functional evaluation is to assess an individual's physical capabilities and limitations in order to determine their eligibility for various social and health assistance programs. This evaluation helps to identify any disabilities, impairments, or functional limitations that may affect a person's ability to perform daily activities, work, or participate in certain programs. The results of the evaluation are used to determine the appropriate level of support and services that the individual may require to maintain or improve their quality of life.

What information must be reported on dshs physical functional evaluation?

The specific information that must be reported on a DSHS (Department of Social and Health Services) Physical Functional Evaluation may vary depending on the specific requirements of the evaluation and the purpose for which it is being conducted. However, some common information that is typically included in this type of evaluation report can include: 1. Identification and contact information of the person being evaluated, such as name, date of birth, address, etc. 2. Medical history, including any previous injuries, surgeries, illnesses, or chronic conditions. 3. Current medications and treatments being undertaken by the individual. 4. Objective measurements of physical abilities and limitations, such as range of motion in joints, strength, balance, endurance, and mobility. 5. Assessment of functional activities and abilities, such as the ability to walk, climb stairs, lift weight, perform self-care tasks, and engage in occupational or recreational activities. 6. Evaluation of pain levels or discomfort experienced by the individual during physical activities. 7. Analysis of any assistive devices or equipment needed by the person to enhance their physical functioning. 8. Recommendations for further interventions, therapies, or assistive devices that may be beneficial for the individual. 9. Any additional observations, notes, or relevant information regarding the individual's physical abilities and limitations. It is important to note that the specific requirements for reporting this information may vary depending on the purpose of the evaluation, such as for disability determination or to inform caregiving or healthcare planning. Therefore, it is recommended to consult the specific guidelines or requirements provided by the DSHS or the evaluating authority.

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