Get Dss 8655 2005

The Dss 8655 form is crucial for the County Department of Social Services to evaluate an individual's medical fitness for employment services, skills training, or medical treatment. This guide provides step-by-step instructions to help users complete the form accurately online.

Follow the steps to successfully complete the Dss 8655 online.

1. Press the ‘Get Form’ button to access the Dss 8655. This action will open the form in your online editor for completion.
2. Begin with Part I, intended for completion by the County Department of Social Services. Fill in required fields such as District Number, Case Number, Date of Birth, Patient Name, Social Security Number, Address, Date, and Case Manager’s Telephone Number.
3. Proceed to Part II, which must be completed by the applicant, recipient, personal representative, or guardian. Here, authorize healthcare providers to disclose health information pertinent to your case.
4. In Part III, which is for the medical provider, ensure that they assess and detail any medical or psychological conditions that may affect work capabilities. If there are no conditions, the provider will simply sign and date the report.
5. The provider needs to note the date and purpose of the recent examination and provide further medical details, including diagnosis and prognosis in the specified fields.
6. Indicate the current work capacity, specifying whether it's full-time or part-time, and outline any work or training restrictions based on the medical assessment.
7. Complete the section indicating the estimated duration for the individual’s condition and its impact on their ability to work or train. Select one of the provided options.
8. The medical provider should finalize the report by assessing the individual's eligibility for referral to Vocational Rehabilitation and adding any additional comments regarding work capacity.
9. Once all sections are filled, the reporting physician must include their name, address, specialty, and signature, followed by the date and their contact number.
10. Review all entries for accuracy before saving your changes. You may choose to download, print, or share the completed form as needed.

Complete your documents online efficiently — start filling out the Dss 8655 today!