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Get SSA HA-1151-BK 1999

us in determining this individual’s ability to do work-related activities, please give us your professional opinion of what the individual can still do despite his/her impairment(s). The opinion should be based on your findings with respect to medical history, clinical and laboratory findings (or lack thereof), diagnosis, prescribed treatment and response, expected duration and prognosis. For each activity shown below: (1) Check the appropriate block; (2) Respond to the questions about the.

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