Get Dhs 1128

The Dhs 1128 form is essential for individuals seeking disability assessment through the State of Hawaii's Med-Quest Division. This guide will provide you with clear and detailed instructions on how to accurately complete each section of the form online.

Follow the steps to effectively complete the Dhs 1128 online.

1. Click ‘Get Form’ button to obtain the Dhs 1128 and open it in the editor.
2. In section I, fill in your name, date of birth, and sex. Ensure all entries are legibly written.
3. For section II, provide a thorough description of all significant physical and mental conditions related to the patient's disability. Include relevant dates and attach any supporting documents.
4. In section III, list current diagnoses, noting the primary diagnosis first. Be specific and concise in your descriptions.
5. Section IV requires you to indicate the treatment plan along with the anticipated duration of treatment. Detail any ongoing treatments or assessments.
6. In section V, elaborate on the patient’s functional limitations regarding medium and light work. Base your comments on medical evidence, avoiding subjective opinions.
7. Section VI involves the licensed physician’s statement of disability. Choose the appropriate expectation duration for the disability and provide the physician's contact details.
8. In section VII, the patient acknowledges receipt and understanding of the report. Ensure the patient or their representative signs and dates the form.
9. After completing all sections, review the form for accuracy, save changes, and then you may download, print, or share the completed Dhs 1128 as needed.

Complete the Dhs 1128 online today and take a step forward in your disability assessment process.