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RFQ 0634-250 DDDS Consultative Psychiatric Examinations 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 Disability (SSI) benefits and the DSHS Non-Grant Medical Assistance program. The purpose of this Request for Qualifications is to expand the list of qualified, contracted physicians to perform psychiatric diagnostic interviews for clients who apply for these benefits. Contact Name Ladd Wikstrom, Contracts Specialist Contact Email ladd.wikstrom@ssa.gov Contact Phone 360.664.7523 Issue Date April 16, 2007 Bidder Questions Due N/A Answers Released N/A Proposal Due Date Within 30 days of electronic download or receipt of mailed hard copies. Solicitation Documents: Legal Notice Request for Qualifcations Document RFQ Exhibit A - Acknowledgement of Professional Qualification and Confidentiality (MD/DO) (Word Format) RFQ Exhibit B - Statement of Agreement for Medical Providers (Word Format) RFQ Exhibit C - Contractor Intake Form, Parts A & B (Word Format) RFQ Exhibit D - Application Checklist RFQ Exhibit E - Sample Contract Contract Exhibit A- Psychiatric Evaluation Guidelines Contract Exhibit B- Child Mental Evaluation Guidelines Contract Exhibit C- Medical Source Statement of Ability to do Work-Related Activities (Mental) Contract Exhibit D- L9 Consultative Examination Voucher Adobe Acrobat Reader is required to view PDF files. You can download it for free. Modified: April 20, 2007 Contact DSHS Central Contract Services for general information about DSHS Procurements at DSHS Central Contracts@dshs.wa.gov For more ways to get in touch with the Department of Social and Health Services go to the DSHS Contact Information Web page. Technical Site Comments:  DSHS Webmaster