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Request for Qualifications 1236-426 DDDS Consultative Medical Examinations

itsap
Purpose
The Department of Social and Health Services (DSHS), Division of Disability determination Services (DDDS), administers the Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and DSHS Non-Grant Medical Assistance programs. The purpose of this Request for Qualifications (RFQ) is to expand the list of qualified, contracted physicians to perform medical examinations for clients who apply for these benefits.
* As of 5/23/14, we are not accepting applications in Kitsap County, Pierce County, Portland (Oregon), Skagit County, Snohomish County, Vancouver, or Whatcom County.

Contact Name
Uyen Kashani, Professional Relations Specialist
Contact Email and Address
Uyen.Kashani@ssa.gov
Department of Social and Health Services
Division of Disability Determination Services
P.O. Box 9303
Olympia, WA 98507-9303
Contact Phone
1-800-562-6074, Ext. 47437
Contact Fax
(360) 664-7359
Submissions
If you are interested in becoming a Consultative Examiner, please submit your application packet to the above address or fax number.
Issue Date
October 26, 2012

Documents

RFQ 1236-426 - Legal Notice - October 26, 2012

RFQ 1236-426 - Request for Qualification

  • Exhibit A - Application Checklist
  • Exhibit B - Acknowledgement of Professional Qualifications & Confidentiality
  • Exhibit C - Statement of Agreement for Medical Providers - Updated July 24, 2014
  • Exhibit D - Contractor Intake Form
  • Exhibit E - Sample Contract – Consultative Medical Examination
  • Exhibit F - Cardiac Specialty Examination
  • Exhibit G - Neurological Specialty Examination
  • Exhibit H - Orthopedic Specialty Examination
  • Exhibit I - Respiratory Specialty Examination
  • Exhibit J - Rheumatology Specialty Examination
  • Exhibit K - Medical Source Statement of Ability to do Work-Related Activities

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