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RFQ 1236-424 DDDS Consultative Medical Exams - Otolaryngology/Pediatric/Vision

Notice:

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 otolaryngology, pediatric, or vision examinations for clients who apply for these benefits.
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
June 17, 2013

Documents:

RFQ 1236-424 - Request for Qualification - June 17, 2013

  • Exhibit A - Application Checklist
  • Exhibit B - Acknowledgement of Professional Qualifications & Confidentiality
  • Exhibit C - Statement of Agreement for Medical Providers-Updated August 20, 2014
  • Exhibit D - Contractor Intake Form
  • Exhibit E - Sample Contract – Consultative Medical Examination – OTO/Ped/Vision
  • Exhibit F - Otolaryngology Specialty Examination
  • Exhibit G - Pediatric Specialty Examination
  • Exhibit H - Vision Specialty Examination

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